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Full text of "The Medical and surgical reporter"

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THE 



MEDICAL AND SURGICAL REPORTER 



A WEEKLY JOURNAL, 



(ESTABLISHED IN 1858, BY S .W. BUTLER, M. D. 



EDITED BY 



33. a-. BE.I1TTOIT, Iv^.3D. 



JANUARY-JULY, 1879. 



OF 






YOL. XL. 



PHILADELPHIA: 

NO. 115 SOUTH SEVENTH STREET. 

18 7 9. 



CONTRIBUTORS 




ALEXANDER, Wm. F., 107. 

ALLEN, R. G., 19. 

ANGNEY, W. M., Report, 53, 94, 118. « 

ARNOLD. Prof. A. B., Clinic, 403. 

BAILY, STEELE, 228. 

BAKER, F. J., 349. 

BARNES, HENRY E. W., 306. 

BEAVER. DANIEL B. D., 225. 

BENNETT, E. P., 172. 

BLACK, J. R., 205, 333. 

BLA.CKWELL, E. T., 109. 

BLAKE, J. D., 336. 

BOUGHTON, W. S., 240. 

BREWER, E. P., 459. 

BRINTON, JOHN H., Clinic, 53, 94, 118, 468. 

BRISTOW, A. F., Report, 230. 

BROWN, J. J., 19. 

BULKLEY, L. DUNCAN, Clinic, 121, 142, 186. 

BULLOCK, J. G., 41. 

BURGE, Dr., Clinic, 231. 

CALHOUN, R. L., 503. 
CASSELBERRY, J. R., 129. 
CHAPMAN, N. H., Report, 273, 317, 381. 
CHEWRING, J., 394. 
CLIPPINGER, H/G,,152. 
COLES. WALTER, 171. 
CORSON, HIRAM, 3, 49, 133, 267, 291. 
COWAN, GEORGE, 219. 
CROTHERS, T. D., 72. 
CURTISS, W. H., 89. 

DA COSTA, Prob-., Clinic, 75, 139, 182, 208, 339, 361. 

DE ARMOND, J. A., 129. 

DICKINSON, G. E., 245. 

DODD, W. S., 42. 

DORA, J. W"., 503. 

DUKE, B. F., 434. 

ELEY, M. J., 327. 
ENFIELD, CHAS., 372. 
ENGEL, HUGO, 265, 357, 434. 
ESKRIDGE, J. T., 512. 
EVERETT, J. T., 136. 

FARNSWORTH, P. J., 338. 
FEGLEY, ORLANDO, 7. 
FOLSOM, N. L., 130. 
FOWLER, R., 239. 
FRKE.VIAN, C. A., 393. 
FUNDENBERG, GEO. B., 243. 

GADSDEN, JOHN W., 417. 

GETZ, C. L., 371. 

GEIZ, H. L., 393, 460, 527. 

GILBERT, S. F., 283. 

GIM, R. ().. 417. 

GREENE, L M., 460. 

GROSS, Prof. S. D.^ Clinic, 247. 

HAMER. Wm. F.. 43. 
HAMILTON, GEORGE, 466. 
HAMILTON, S. M., 28, 171, 26L 
HAMMOND, Prof. Wm. A., Clinic, 30. 
HENDRICK, H. W., 153. 
HENNING, JOHN A., 65. 
HER RICK, O. E., 180, 350, 360, 442. 
HICKMAN, J. W., 39;, 527. 
HILL, J. LINSEY, 370,400. 
HINKLE, FRANKLIN, 52. 
HOFFMANN, W. J., 157. 
HOKNER, FRED., 269. 
H()RTON,H. L.. 533. 
HOYT, W. D., 240. 
HUTCHINSON, J. A., 153. 
HUTCHINSON, J. C, Clinic,2S6. 
HUTT, W. H., 108. 

JACOBI, Prof. A., 1. 



KEEN, W. W., 331. 
KELLY, H. R., 43. 
KENNEDY, N. B., 443. 
KEYSER, P. D., 199. 
KILPATRICK, A. R., 85, 434. 
KIRK, R. M., 372. 

LEE DOM, OSCAR, 548. 
LEVIS,- R. J., Clinic, 273, 317, 38L 
LEWIS, C. H., 5. 

MATTHEWS, THOMAS W., 316. 

MAXSON, E. R., 20. 

McCLANAHAN, J. P., 305. 

McCLANCHARD, J. P., 64. 

Mo(30ART, JAMES, 327. 

McLANAHAN, H. M., 468. 

MEDBERY, J. N., 460. 

MERRICK, C. H., 335. 

MITCHELL, J. D., 223. 

MORRIS, JOHN, 350. 

MOSELEY, H. A., 459. 

MURDOCK, F. H., 328. 

MYERS, WORTHINGTON, Report, 30, 155, 271. 

NICKERSON, S. A., 85. 
NORRIS, J. N.,i51. 
NOWLIN, J. H., 128, 282. 

OLIVER, CHAS. A., Report, 8. 

PATTERSON, W. F., 172. 

PEPPER, Prof, Wm., Clinic, 8. 

PORTER, F. F., 306. 

PORTER, P. BRYNBERG, Report, 424, 444. 

RAWLS, J. A., 42. 
READ, Wm.,177. 
REYNOLDS, DUDLEY S., 195. 
ROSE, W. H., 35L 
RUSH, E.W., 526. 

S A JO US, CHAS. E., Report, 16L 

SCOTT, ANDREW J., 107. 

SCRUTON, J. E.,305. 

SCHOLL. E. H., 218, 327. 

SHIVERS, C. G., 402. 

SHOEMAKER, JOHN V., 529. 

SIGSBEE, W., 85, 417. 

SMART, A. R., 441. 

SMITH, ROBERT MEADE, 111, 309, 875, 507. 

SOZINSKEY, T. S., 70, 221, 353. 

SPOTTISWOOD, E. T., 152. 

STEINRIEDE, J. J., 530. 

STI1.LMAN, W. O., 397, 419. 

SUTTON, R. STANSBURY, 485. 

THOMAS, J. P., 283. l 

THOMAS, T. GAILLARD, Clinic, 424, 444. * 
TILFOKD, J. H., 153. 
TURNBULL, CHAS. S , Clinic, 161. 
TURNBULL, LAURENCE, 45, 67. 
TURNBULL, R. J., 417. 

VANCE, REUBEN A., 23, 91, 115. 
VANDERBECK, C. C, 86, 294, 415, 502, 545. 
VARIAN, Wm., 246, 272. 

WASHBURNE, J. B., 198. 

WERTZ, T., 460. 

V.^EST, S. L., 218. 

WIGHT, J. S., 463. 

WOODBURY, FRANK, Report, 75, 139, 182, 208, 247, 

287, 339, 361, 546. 
WOODRUFF. MORGAN L., Report, 231, 
WYLIE, WINFRED, Report, 31, 250. 

YOUNG, G. K., 350. 



IISTDEX 



Abdominal tumor, 406. 

Aboriginal races of the southwest, their practice 
of medicine and surgery, 157. 

Abortifacient, pilocarpin as an, 127. 

Abortive treatment of bubo, 2f60. 

Abscess; hepatic ; is it safe to puncture in? 17, 
89 ; frequency of, 171 ; cases of, 251 ; con- 
cealed, 369 ; antiseptic treatment of, 519 ; fol- 
lowing empyema, 249 ; of liver opening through 
the lungs, 459. 

Absorption of cataract by internal medication, 
388. 

Abuse, self, prevention of, 345. 

Abuses of the obstetric forceps, 261. 

Accidents ; chloroform, 237 ; fatal, from anaes- 
thetics, prevented, 388. 

Acetate; of potassa, 65 ; of lead in internal hem- 
orrhage, 501. 

Acid ; carbolic, in malarial disease, 553 ; car- 
bo7iic, gas, the action of beverages charged 

- with, 348; chronic; warts treated by, 217 ; in 
epithelial cancer, 275 ; in affections of the 
mouth, 478 ; chri/sophanic, 260, 278 ; copaivic, 



86; pyrogallic; in hgemoptysis, 83 



pso- 



riasis, 304; salicylic; eruption from, 18; pro- 
longed daily use of, 84 ; enemata of, in dysen- 
tery, 238 ; injected into the bladder for cystitis, 
with retention of urine, 283 ; vieiric, 277 ; 
phosphate, Horsford's, 505. 

Acne, its nature and treatment, 79, 142. 

Aconite ; and iodide of potassium in thoracic 
aneurism, 275 ; as a therapeutical agent, 407. 

Act ; medical ; Kansas, 172 ; Wisconsin, 307. 

Action ; physiological, of coffee, 40 ; of large 
doses of capsicum, 124 ; of substances on the 
teeth, 238 ; of remedies on the liver, 342 ; of 
beverages charged with carbonic acid gas, 348 ; 
of quinine, 350; against adulteration, 508. 

Acts to control contagious diseases, their results, 
150. 

Actual cautery ; use of the, 39 ; in the treatment 
of paraplegia from spinal sprains, 274. 

Acute; nephritis, 31, 339 ; ophthalmia, ergotine 
in, 34 ; laryngitis in the adult, ice treatment of, 
151 ; tubal nephritis, treatment of, 210 ; ob- 
struction of the bowels, treatment of 298 ; ex- 
acerbation of cirrhotic kidney, with peritonitis 
and pleurisy, simulating typhoid fever, 362 ; 
mania, 404. 

Adeno-sarcoma of the ovary removed by lapar- 
otomy, 424. 

Administration of the sulphides, 538. 

Adolescents, chronic intermittent albuminuria 
of, 123. 

Adult, ice treatment of acute laryngitis in the, 151. 

Adulterated ; chloroform, 170 ; drugs, 368. 

Adulteration, action against, 506. 

Advance of the plague, 149. 

Advantages of the country practitioner, 466. 

Affections ; of the eye, resulting from reflex irri- 
tation, 199 ; of the mouth, chromic acid in, 478. 

After treatment in operation for equino-varus, 
without mechanical appliances, 384. 



Age of the mother, in relation to the sex of the 
child, 304. 

Agent, therapeutic, aconite a, 407. 

Agents, medicinal, sea weeds as, 501. 

Ages, remarkable, 263. 

Air ; of stables, 18; cool, in treating measles, 414. 

Albuminoid or amyloid kidney, 362. 

Albuminous substances in the urine, 33. 

Albuminuria ; chronic intermittent, of adoles- 
cents, 123 ; as an element of prognosis in 
typhoid fever, 139 ; success of ergot and iron 
in, 210 ; oxygen in, 238, 454 ; of pregnancy 
treated by jaborandi, 326 ; fuchsin in, 458. 

Alcohol ; antagonistic to diphtheria, 5, 128, 196, 
282 ; therapeutic uses of, 12 ; mortality from, 
40 ; and phthisis, 194. 

Alcoholics, consumption of, 110. 

Alcoholism ; 299, 362 ; the forms of, 524. 

Alleged; poisonous dose of veratrum viride, 238 ; 
cure for intemperance, 282 ; blindness from ■ 
sewer gas, 549. 

Alum in chronic dysentery, 232. 

Alumni of Jefferson College, 263. 

Amblyopia from the use of tobacco, 193, 

American; pork, trichina tn, 107 ; medical asso- 
ciation, thirtieth annual meeting, 477 ; associa- 
tion for the cure of inebriates, 516 ; laryngo- 
logical association, 550. 

Ammonium, chloride of in delirium tremens, 259. 

Amount of quinine used, 281. 

Amputation ; of the thigh in its middle third, 
317 ; of the leg, results of, 319. 

Aneesthesia ; induced, or symmetrical, 128 ; pre- 
cautions in, 458. 

AnaBsthetic ; iodoform as a local, 12 ; leprosy, 
nerve stretching in, 255. 

Anaesthetics ; minimizing the dangers of, 194 ; 
religious objections to, 304 ; prevention of 
fatal accidents from using, 388 ; new experi- 
ments in, 537. 

Anal fissure, treatment of, 485. 

Analogies between plants and animals, 217. 

Anasarca, surgical treatment of, 144, 300. 

Anatomy, comparative, of the olfactory appa- 
ratus, 348. 

Anencephalus monster, 152. 

Aneurism; popliteal, Esmarch's bandage in, 145; 
thoracic, iodide of potassium and aconite in, 
275 ; internal, 451. 

Angina, gargle for, 217. 

Animals; analogies between plants and, 217 ; 
lower, relations of their diseases to those of 
man, 235. 

Antagonism ; in drugs, the forms of, 61 ; of al- 
cohol to the poison of diphtheria, 128. 

Antecurvature of the uterus, 124. 

Antero-posterior flap operation in amputation of 
the thigh, 317. 

Anthropological section of the Paris Exhibition, 
20. 

Antidote; to strychnia, monobromide of cam- 
phor as an, 18; to arsenic, dialysed iron an, 
434. 



IV 



Index, 



Antiseptic ; surgery, successes of, 84 ; treatment 
of empyema in children, 278; of hepatic ab- 
scess, 519. 

Aorta, gunshot wound of heart involving the, 188. 

ApoUinaris water, 373. 

Apoplexy ; with hemiplegia and syphilitic brain 
disease, 77 ; venesection in, 259. 

Apparatus, olfactory, comparative anatomy of 
the, 348. 

Appliances ; mechanical, avoided in after treat- 
ment of operation for equino-varus, 384 ; sur- 
gical, small elastic bands as, 460. 

Application ; of the Darwinian doctrines to the 
study of disease, 148 ; of sulphate of copper, 
relief of pain from, 194 ; of patents, trade- 
marks and copyrights to pharmaceuticals, 215; 
of recent inventions to medicine, 501. 

Approaching death, a sign of, 413. 

Arkansas medical college, 395. 

Army of Russia, its medical staflp, 131. 

Arrest of commencing pyaemia by an operative 
measure, 166. 

Arsenic ; in heart disease, 282 ; dialysed iron as. 
an antidote to, 434. 

Arthritis, rheumatic, poultices in, 165. 

Ascites, compression in, 370. 

Aspiration, shall it be used in the effusion of 
pleurisy complicated with phthisis, 138. 

Assistants, female, in insane hospitals, 546. 

Associations for sanitary protection, 110. 

Asthma ; leonurus c%rdiaca in, 152 ; nitrous ox- 
ide in, 431. 

Atomized ether in pertussis, 325. 

Atrophy, progressive muscular, its pathology, 189. 

Atropia ; in urticaria, 370; in whooping cough, 
478. 

Attention, expectant, effects of, 236. 

Average, the law of, in suicides, 237.. 

Babies, ephemeral paralysis of, 194. 

Ball pessary, rubber, 108. 

Balsam of Peru in wounds, 370. 

Bandage ; Esmarch's, in popliteal aneurism, 145 ; 
solid india-rubber, 369. 

Bands, small elastic, as surgical appliances, 460. 

Banquet, Gross, proceedings of the, 394. 

Bark, wahoo, fluid extracts of, 418. 

Base of the radius, fracture of the, 463. 

Bathing, is it healthful ? 478. 

Baths, electric, how to give them, 101. 

Battle of the giants over evolution, 38. 

Bearing, ethical, of an alleged poisonous dose of 
veratrum viride, 238. 

Belladonna, therapeutic uses of, 320. 

Berries, palmetto, their uses, 525. 

Best form of mercury for hypodermic use, 63. 

Beverages charged with carbonic acid gas, action 
of, 348. 

Beware of impostors, 86. 

Bladder ; human, inversion of the, 91, 115 ; early 
symptoms of stone in the, 234; irritable, 248 ; 
injections of tannic and salicylic acids into the, 
for cystitis, with retention of urine, 283 ; fe- 
male, excessive irritability of the, treated by 
Teale's method, 471. 

Blight, potato, relation of diphtheria to the, 150. 

Blindness ; color ; remedy for, 325 ; legal rela- 
tions of, 504 ; alleged, from sewer gas, 549. 

Blood ; transfusion of, 230 ; enricher, iron a, 
433. 



Board ; of experts who investigated the yellow 
fever epidemic, report of, 130 ; of health, na- 
tional, organized, 329 ; Philadelphia, resolu- 
tions of, 373 ; of North Carolina, 373. 

Bodies ; fatty, solubility of alcohol in, 40 ; for- 
eign, removal of, from ear and nose, 195, 387. 

Body ; foreign ; in the stomach, 153 ; removed 
from the ear, 163 ; in the oesophagus, 260, 393 ; 
fluids of the, 525. 

Botany, medical and general, of the Pacific 
States, 500. 

Bougie ; flexible metallic, 350. 

Bowels, treatment of acute obstruction of the, 
298. 

Bow legs, management of, 458. 

Brain ; disease, syphilitic, 77 ; compression of, 
from clot, 273 ; size of the, 478. 

Brazil ; smallpox in, 131 ; sufferings in, 197. 

Breech and shoulder presentation in a twin 
labor, 327. 

Brief hints in the progress of otology in 1878, 45, 
67. 

Bright' s disease, chronic, 340. 

Bromide of potassium in croup, 433. 

Bromine in croup, 325. 

Broncho-pneumonia, intermittent, 387. 

Bubo, the abortive treatment of, 260. 

Bulletin of the public health, extracts from the, 
66, 284, 417, 549. 

Burial alive, statistics of, 483. 

Burn, and its treatment, 335. 

Burn Brae private hospital, 549. 

Burns, the soda treatment of, 170. 

Bursitis, syphilitic, 123. 

Calcined magnesia, dangers of its use as a lax- 
ative, 129. 

Calculus ; vesicae, with a hair pin as its nucleus, 
10 ; examination for, 248 ; impacted urethral, 
539. 

Camphor, monobromide of, as an antidote to 
strychnia, 18. 

Cancer, epithelial, treated by chromic acid, 275. 

Cantharidine in naevi, 326. 

Capsicum, the action of large doses of, 124. 

Carbolic ; injections in the treatment of piles, 458; 
acid, in malarial disease, 553. 

Carbonic acid gas in beverages, 348. 

Care for the eyes, how to, 237. 

Caries, dental, 220. 

Cascaro sagrado again, 175. 

Case ; of puerperal convulsions, 42 ; of scrofula, 
43 ; of trephining, 43 ; of extra-uterine preg- 
nency, 52, 242, 372 ; of erysipelas, 86 ; of epi- 
lepsy, 129 ; of disseminated spinal sclerosis, 
141, 182; in ophthalmic diagnosis, 195; of 
diabetes mellitus, 218 ; of sympathetic oph- 
thalmia, 225 ; of congenital hernia, 231 ; of 
alleged poisonous dose of veratrum viride, 
238 ; of umbilical hernia, 246 ; of hysterical 
hyperaesthesia treated by metalloscopy, 265 ; 
of ovariotomy, 272, 441, 630; of confinement, 
370; of traumatic tetanus, 402; of puerperal 
convulsions, 443 ; of hydrophobia, 479 ; of 
hereditary malarial poisoning, 526; a startling, 
648 ; of stramonium poisoning, 648. 

Caseous pneumonia, 32. 

Cases ; of hepatic abscess, 261 ; of uterine hem- 
orrhage, warm fomentations to the head in, 
278 ; of dyspareunia, 344 ; of stricture and 



Index, 



gleet treated with galvanism, 360, 442 ; of 
diphtheria, 393 ; of insanity, 403 ; illustrating 
the use of koumiss, 406 ; of lithotomy, 468, 
469. 

Cataract, absorption of, by internal medication, 
388. 

Catarrh ; naphthaline in, 326 ; of the stomach, 
treatment of, 364. 

Cattle, the pleuro-pneumonia of, 415.- 

Causation of septicsemia, 276. 

Cause ; of yellow fever, 64 ; of deformity in frac- 
ture of the lower end of the* radius, 166; of 
death in hanging, 195 ; exciting, of sympa- 
thetic ophthalmia, 225 5 proximate, cf dyspep- 
sia, 233. 

Causes ; of concealed post-partum hemorrhage, 
28; of heat in fever, 64; of mortality, 221. 

Cautery, actual; use of the, 39 ; in the treatment 
of spinal sprain, 274. 

Cephalgematomata, spontaneous, 326. 

Cerebral ; congestion, 30 ; symptoms in the in- 
fluenza epidemic, 208. 

Cerebro-spinal sclerosis, multiple, 357. 

Certain diseases, advantages of the country prac- 
titioner in the study of, 466. 

Certainty in medical reasoning, the grounds of, 
60. 

Certificates of insanity by physicians, 462. 

Cervix; laceration of the, 428 ; ulcerations of the, 
524. 

Chair, easy, the physiology of an, 63. 

Chancres, hard, excision of, 544. 

Change, remarkable and gratifying, 127. 

Chapped hands, 347. 

Characteristic ; phenomena of the influenza epi- 
demic, 208 ; symptoms of compression of the 
brain from clot, 273. 

Charbon, theory of death in, 170. 

Charcot's crystals, 458. 

Charities, medical, of Philadelphia, 86. 

Cheap doctors, 483. 

Child ; bearing, early, 238 ; relation between thfe 
age of the mother and the sex of the, 304. 

Children ; diseases of, 1 ; ice treatment of croup 
in, 151 ; incontinence of urine in, 190, 410 ; 
antiseptic treatment of empyema in, 278 ; 
chloroform in convulsions of, 336 ; diphtheria 
in, 460. 

Chloral ; solubility of, in fatty bodies, 40 ; in 
migraine, 63 ; -chloroform, 86 ; in the treat- 
ment of traumatic tetanus, 177 ; a cause of cu- 
taneaus eruptions, 413 ; in diphtheria, 533. 

Chlorate, of potash, poisoning by, 150, 349. 

Chloride of ammonium in delirium tremens, 259. 

Chlorine in diphtheria, 84, 172, 196. 

Chloroform ; in labor, 32 ; adulterated, 170 ; ac- 
cidents, 237 ; in diseases of the heart, 277 ; in 
convulsions of infants and children, 336. 



soda in, 347 ; a theory and therapeusis for, 
414. 

Chromic acid ; warts treated by, 217 ; in the 
treatment of epithelial cancer, 275 ; in affec- 
tions of the mouth, 478. 

Chronic ; starvation, its effects on the mind, 63 ; 
intermittent albuminuria of adolescents, 123 ; 
pleurisy with effusion, 138 ; tubal nephritis, 
treatment of, 210 ; dysentery, alum in, 232 ; 

' metritis, surgical treatment of, 254 ; granular 



pharyngitis, 259 ; nephritis, 298 ; Bright' s dis- 
ease, and tubal nephritis, 340 ; alcoholism, 
effects of, 362; ovaritis, 444, 497. 
Chrysophanic acid, 260, 278. 
Cinchona, the medical use of, 520. 
Circular in reference to the Bulletin of the Pub- 
lic Health, 549. 
Circulation, effects of quinine on the organs of™ 

430. 
Cirrhosis, copaiba in, 33. 
Cirrhotic kidney, 362. 

Cities, southern, neglect of sanitary precautions 
in, 411. 

Civil life, scurvy in, 75. 

Cleansing the stump in amputation, 319. 

Cleft palate, Lan^enbeck's operation for, 190. 

Climate ; of Italy, 198 ; its effects in phthisis and 
rheumatism, 392 ; of Nice, 544. 

Clinical ; studies of inebriety, 72 ; features of 
disseminated sclerosis, 141 ; concomitants oi 
idiopathic erysipelas, 287 ; lectures, reporting, 
479 ; consideration of functional disorders in 
digestion, 512. 

Clot, compression of the brain from, 273. 

Coffee ; the physiological action of, 40 ; extract 
of, 505. 

Cold ; in the head, eucalyptus in a, 238 ; water im 
typhoid fever, 408 ; douche treatment of trau- 
matic meningitis, 536. 

College, medical ; medical education before en- 
tering and after leaving, 258 ; commencements.. 
262 ; of Arkansas, 395. 

Color blindness ; remedy for, 325 ; legal rela- 
tions of, 604. 

Commencements ; Yale, University of Maryland, 
Bellevue Hospital Medical College, 241 ; Jef- 
ferson, University of Pa., 262; Woman's, 
Philadelphia, 284. 

Commencing pyaemia, an operative measure for 
the arrest of, 166. 

Comparative ; anatomy of the olfactory apparatus, 
348 ; epidemiology, 432. 

Complete outward dislocation of the forearm j. 
250. 

Complication, extraordinary, in congenital her- 
nia, 231 ; of fibro-cystic tumor of the uterus 
with pregnancy, 427. 

Compound fracture of the left leg, 463. 

Compression ; of the brain, from clot, 273 ; in 
ascites, 370. 

Concealed ; post-partum hemorrhage, causes of,, 
28 ; hepatic abscess, 369. 

Conception, the physiology of, 349. 

Conclusions regarding dipsomania, 58. 

Concomitants, clinical, of idiopathic erysipelas,. 
287. _ 

Condition, filthy, of New Orleans, 198. 

Conditions necessary for contagion to spread, 58. 

Confinement, notes of a case of, 370. 

Congenital; hernia, 231 ; sinus, from the pharynx; 
to the surface of the neck, 247. 

Congestion, cerebral, 30. 

Conjunctiva, removal of epithelioma of, without 
injury to the sight, 188. 

Connection, sexual, treatment of exhaustion from, 
409. 

Consciousness as a mental factor, 348. 

Consumption ; quick, 32 ; prevention of, 108 ; of 
alcoholics, 110; syphilitic, 370; oedema of the 
feet and legs in, 430 ; creasote in, 433... 



VI 



, Index. 



Contagion; of yellow fever, 41, 305, 454 ; condi- 
tions necessary for it to spread, 58 ; of tuber- 
culosis, 82 ; nature of, 104 ; of diphtheria, 503. 

Contagious diseases; acts, their results, 150; 
their prevention in schools, 552. 

Contagiousness of yellow fever, 240. 

Continued precautions against the plague, 307. 

Contracted kidney, 362. 

Controlling prostitution, English measures for, 
522. 

Convention, sixth decennial pharmacopoeia, 394. 

Convulsions ; puerperal, 42, 107, 171,^ 306, 327, 
443 ; from reflex irritation, value of morphia 
hypodermically in, 218 ; delivery in, 240 ; of 
infants and children, chloroform in, 336. 

Convulsive tic, stretching the facial nerve for, 83. 

Cool air and water treatment of measles, 414. 

Copaiba, in cirrhosis and jaundice, 33. 

Copaivic acid, 86. 

Copper, sulphate of, for the relief of pain, 195. 

Copperas as a disinfectant, 304. 

Copyrights, as applied to pharmaceuticals, 215. 

Corns, cure of, 347. 

Cosmetic preparations, 169. 

Cough ; hysterical, pathology of, 42 ; relief of, 
in phthisis, 304 ; whooping, treatment of, 366, 
475 ; night, 408. 

Country practitioner, his advantages and duty, 
466. 

Courses of lectures to graduates, 219. 

Coxalgia, 119. 

Cramp of the muscles, 246. 

Creasote ; as a disinfectant, 322 ; in consumption, 
433. 

Cremation ; in London, 154 ; the progress and 
varieties of, 280. 

Crepitation in the knee joint, in rachitis, 1. 

Croton ; oil treatment of nsevus, 128 ; chloral, 498. 

Croup ; Grerman treatment of, 12 ; similarity to 
diphtheria, 19 ; in children, ice treatment of, 
151 ; symptoms of, 275 ; membranous, trache- 
otomy in, 277 ; bromine in, 325 ; bromide of 
potassium in, 433. 

Crushed elbow joint, 320. 

Cul-de-sac, Douglas', phlegmon in, 427. 

Curara, in epilepsy, 107. 

Cure ; physiological, of hemorrhoids, 136 ; for 
intemperance, 282 ; of corns, 347 ; of rabies 
by oxj^gen, 433 ; of the opium habit, 525 ; of 
irritable ulcer of the rectum by forcible dilata- 
tion, 526. 

Curious twin monster, 21. 

Cutaneous eruptions caused by chloral, 413. 

Cyst ; of vulvo- vaginal canal, 426 ; of the mouth, 
539. 

Cystitis, treated by injections of tannic and sali- 
cylic acids into the bladder, 282. 

Cysto-sarcoma of ovary, 109. 

Daily use of salicylic acid, 84. 

Dangers ; in the use of calcined magnesia as a 

laxative, 129; of anaesthetics, 194; of chloride 

of potash, 349. 
Darwinian doctrines as applied to the study of 

disease, 148. 
Death ; in septicaemia and charbon, 170 ; in 

hanging, cause of, 195 ; from uraemia, 361 ; 

approaching, a sign of, 413. 
Decennial pharmacopoeia convention, the sixth. 



Decline of psoriasis, 122. 

Defective drainage, an endemic of typhoid fever 
from, 97. 

Deficient secretion of milk, treatment for, 525. 

Deformity, the cause of, in fracture of the lower 
end of the radius, 166. 

Delirium tremens, chloride of ammonium in, 
259. 

Delivery ; in convulsions, 240 ; by the forceps, 
before the os uteri is fully dilated, 254. 

Delusions, medical, 294. 

Demonstrations of the germs of infectious dis- 
eases, 457. 

Dental caries, 220. 

Derivation of human parasites from eating fish, 
19. 

Derivatives ; of petroleum, in pharmacy and 
medicine, 324 ; of salicin, 475. 

Dermatology, didactic lectures on, 20. 

Descent, hereditary, of disease, 155. 

Destruction of the tongue, 381. 

Development ; of the Graafian follicles during 
pregnancy, 40 ; spontaneous, of typhus, 255. 

Dextro-quinine, the use of, 85, 307. 

Diabetes mellitus, studies on, 11, 218. 

Diabetics, a practical diet table for, 233. 

Diagnosis ; of scurvy, 75 ; the microphoiie in, 
84 ; ophthalmic, 195 ; percussion of the skull 
as a mode of, 213 ; of myocarditis, 278 ; of 
vaccino-syphilis, 407 ; between erythema and 
mild scarlatina, 452. 

Diagnostic points, Westphal's, in locomotor 
ataxia, 18. 

Dialysed iron an antidote to arsenic, 434. 

Diarrhoea ; in an infant, from improper feeding, 
1 ; koumiss in, 365 ; the hot water douche in. 
433. 

Didactic lectures on dermatology, 20. 

Diet ; of the gouty, 80 ; table for diabetics, 233 ; 
milk, in dysentery, 347. 

Differences between zymotic and septic poisons, 
34. 

Different races, the pulse in, 458. 

Digestion; gastric, 375, 507; functional dis- 
orders of, 512. 

Digitalis ; in heart disease, 57 ; in suppression 
of urine, 166 ; exhibition of, 366. , 

Dilation ; of the os uteri, 124, 409 ; for sterility, 
344; of the sphincter vesicse, 471 ; of the rec- 
tum for ulcer, 526. 

Diphtheria; antagonism of alcohol to, 5, 128, 
196, 282; chlorate of potash in, 19; similarity 
of croup to, 19 ; the pathology of, 40; potato 
eating and, 61, 150, 283 ; value of chlorine in, 
84, 172 ; prevalence of, 88 ; in fowls, 326 ; 
some cases of, 393 ; treatment of, 12, 56, 165, 
321, 400, 430; in children, 460 ; the contagion 
of, 503 j chloral locally in, 533. 

Diphtheritic poison, its source, 192. 

Diploma selling, 175. 

Dipsomania, conclusions regarding, 58. 

Discouraging science, 194. 

Discoveries regarding the nature of contagion. 
104. 

Discovery of a plagiarism, 369. 

Disease ; of the heart, digitalis in, 57 ; arsenic 
in, 282 ; hereditary transmission of, 127, 155 ; 
uterine, its influence on nervous disorders, 63 ; 
syphilitic brain, 77 ; Darwinian doctrines as 
applied to the stud'y of, 148 ; physical, result- 



Index. 



Vll 



ing from mental strain, 271 ; obscure pulmo- 
nary 316 ; chronic Briglit's, 340 ; pulmonary- 
type of, 394 ; respiratory, an undescribed 
form of, 537 ; rest in, 544 ; malarial, carbolic 
acid in, 553. 

Diseases; of children, 1 ; of the membrana tym- 
pani, 67 ; contagious, results of the acts con- 
trolling them, 150 ; of the lower animals, their 
relation to those of man, 235 ; malarial, War- 
burg's tincture in, 255; of the heart, chloro- 
form in, 277; wasting, mead in, 370; infec- 
tious, demonstrations of the germs of, 457 ; 
advantage of the country practitioner in the 
study of, 466 ; of the skin, external treatment 
of, 529 ; contagious, in schools, 552. 

Disinfectant, creasote as a, 322. 

Disinfectants, 304. 

Disinfection, refrigeration as a means of, 462. 

Dislocation, outward, of the forearm, 250. 

Disorders, nervous, influence of uterine disease 
on, 63. 

Displacements, uterine, instrumental interfer- 
ence in, 180. 

Disseminated sclerosis following spinal menin- 
gitis, 141, 182. 

Dissimilarities, personal, 260. 

Divided tendons reunited, in open wounds, 223. 

Doctrines ; of Darwin, as applied to the study of 
disease, 148 ; sound, in therapeutics, 282. 

Dorsal vertebra, second, involved in a gunshot 
injury, 228. 

Dose, alleged poisonous, of tincture veratrum 
viride, 238, 305. 

Doses ; large, of capsicum, their action, 124 ; 
small, 350. 

Double ovariotomy, 272. 

Douche ; hot water, in diarrhoea, 433 ; cold, in 
traumatic meningitis, 536. 

Douglas' cul-de-sac, phlegmon in 427. 

Drainage, defective, an endemic of typhoid fever 
from, 97. 

Dressing the stump, in amputation, 319. 

Dropsy, success of jaborandi in, 210. 

Drugs ; forms of antagonism in, 61 ; adultera- 
tion of, 368. 

Duties appertaining to the new year, 16. 

Duty ; on quinine, 462, 505 ; of the country 
practitioner, 466. 

Dyes, poisonous, 524. 

Dysentery; malignantgastro-enteric, 12; chronic, 
alum in, 232 ; salicylic acid enemata in, 238 ; 
new remedy in, 347 ; milk diet in, 347. 

Dysmenorrhoea ; 444 ; spasmodic, mechanical 
treatment of, 474. 

Dyspareunia, cases of, 344. 

Dyspepsia, a neglected proximate cause of, 233. 

Ear ; removal of a foreign body from the ; three 

years after its introduction, 163 ; process of, 

195, 387. 
Early ; symptoms of stone in the bladder, 234 ; 

child bearing, 238. 
Easy chair, physiology of an, 63. 
Eating ; fish, human parasites derived from, 19 ; 

potatoes, relation of to diphtheria, 61. 
Eczema ; produced by oxyurides, 62 ; of the 

head and face, 186 ; oleate of zinc in, 478. 
Editorials — 

The New Year and its Duties, 16. 

A Battle of the Giants over Evolution, 38. 



The Grounds of Certainty in Medical Reason- 
ing, 60. 
The Contagion of Tuberculosis, 82. 
Late Discoveries Regarding the Nature of 

Contagion, 104. 
The Theories of Epidemiology, 126. 
The Darwinian Doctrines as Applied to the 

Study of Disease, 148. 
The Advance of the Plague, 149. 
Cosmetic Preparations, 169. 
The Source of the Diphtheritic Poison, 192. 
Patents, Trade Marks, and Copyrights, as ap- 
plied to Pharmaceuticals, 215. 
The Diseases of the Lower Animals, in their 

Relations to the Diseases of Man, 235. 
Medical Education before Entering and after 

Leaving the Medical College, 258. 
The Progress and Varieties of Cremation, 280. 
The Sense of Smell, 302. 
Petroleum and its Derivatives in Pharmacy 

and Medicine, 324. 
Quarantine and the Plague, 346. 
The Adulteration of Drugs, 368. 
The Growth and Worth of the Metric System, 

391. 
The Neglect of Sanitary Precautions in the 

Southern Cities, 411. 
Medicine and Medical Men in Russia, 411. 
Remarks on Comparative Epidemiology, 432. 
The increase of Physical Evil and its Remedy, 

456. 
Demonstrations of the Germs of Infectious 

Diseases, 457. 
The Thirtieth Annual Meeting of the Ameri- 
can Medical Association, 477. 
The Medical and General Botany of the Pacific 

States, 500. 
English Measures for Controlling Prostitution, 

522. 
Life Insurance Companies and Physicians, 523. 
The Question of Quarantine, 543. 
Watering Place Physicians, 551. 

Education, medical, before entering and after 
leaving the medical college, 258. 

Effects ; of chronic starvation on the mind, 63 ; 
of expectant attention, 236 ; of opium smok- 
ing, 260 ; of tobacco, 276 ; of chronic alcohol- 
ism, 362 ; of climate in phthisis and rheuma- 
tism, 392 ; of quinine on organs of circulation, 
430 ; of elevated regions on phthisis, 540. 

Effort, mental, a perilous form of, 545. 

Effusion of pleurisy, shall it be removed by as- 
piration, when complicated with phthisis, 138. 

Egypt, health resorts in, 106. 

Either sex, influence of season on the mortality of, 
353. 

Elastic bands, small, as surgical appliances, 460» 

Elbow joint, crushed, 320. 

Electric ; baths, how to give them, 101 ; mirror, 
a new, 545. 

Elements of prognosis in typhoid fever, 139. 

Elevated regions, for phthisis, 540. 

Emphysema, post-mortem, 100. 

Empyema ; with spontaneous opening, followed 
by an immense abscess, and a permanent fis- 
tula, with pneumothorax, 249 ; in children, 
antiseptic treatment of, 278. 

Emulsifying, the physics of, 392. 

Endemic of typhoid fever, from defective drain- 
age, 97. 



Vlll 



Inaex, 



Enemata ; of salicylic acid in dysentery, 238 ; 
nutritive, value of, 412. 

English measures for controlling prostitution, 
522. 

Enlarged glands, treatment of, 371. 

Enricber of the blood, iron an, 433. 

Ephemeral paralysis of babies, 194. 

Epidemic ; of yellow fever, report of the experts 
who investigated it, 130 ; of influenza, 208, 
349 : of obscure pulmonary disease, 316. 

Epidemics ; meteorology and, 338 ; progress of, 
372. 

Epidemiology ; the theories of, 126 ; compara- 
tive, 432. 

Epididymitis, gonorrhoeal, 260. 

Epilepsy ; curare in, 107 ; treatment of, 129 ; 
etiology of, 144. 

Epithelial cancer treated by chromic acid, 275. 

Epithelioma of conjunctiva removed without in- 
jury to the sight, 188. 

Equine virus for vaccination, 413.* 

Equino-varus, after treatment without mechani- 
cal appliances, in operation for, 384. 

Ergot and iron, their success in albuminuria, 
210. 

Ergotine ; in acute ophthalmia, 34 ; supposi- 
tories of, in uterine fibroids, 365 , in strangu- 
lated hernia, 388. 

Eruption ; from salicylic acid, 18 ; cutaneous, 
caused by chloral, 413. 

Erysipelas ; pathology and treatment of, 55 ; a 
case of, 86 ; idiopathic, and some of its clinical 
concomitants, 287. 

Erythema, diagnosis between it and mild scarla- 
tina, 452. 

Erythematous fevers, belladonna in, 320. 

Esmarch's bandage in popliteal aneurism, 145. 

Ether ; atomized in pertussis, 325 ; inhaler, 505. 
.Ethical bearing of an alleged poisonous dose 
of tincture veratrum viride, 238. 

Ethylates of sodium and potassium, 80. 

Eucalyptus ; in a cold in the head, 238 ; exten- 
sion of the plantation of, 281. 

Euonymus atropurpureus, 333. 

Europe, the plague in, 110. 

Evil, physical, the increase of, 456. 

Evolution, battle of the giants over, 38. 

Exacerbation of cirrhotic kidney, with peritonitis 
and pleurisy, simulating typhoid fever, 362. 

Examination ; for calculus, 248 ; of the urine for 
spermatozoa, 501 ; of seamen, 554. 

Excessive irritability of female bladder treated 
by Teale's method of forced dilatation, 471. 

Excision : of the head of the femur, for intracap- 
sular fracture, 188 ; of hard chancres, 544. 

Exciting cause of sympathetic ophthalmia, 225. 

Exhaustion from sexual connection, treatment 
of, 409. 

Exhibition ; in Paris, the anthropological sec- 
tion, 20 ; of digitalis, 366. 

Exophthalmic goitre, 211. 

Expectant attention, effects of, 236. 

Experimental physiology. 111, 309, 375, .507. 

Experiments: in transfusion, 79 5 on malignant 
pustule, 144; in metalloscopy, 370; in anaes- 
thetics, 537. 

Experts, who investigated the yellow fever epi- 
demic, their report, 130. 

Expulsion of the placenta, posture in, 553. 

Extension of the eucalyptus plantation, 281. 



External ; use of digitalis in suppression of the 
urine, 166; treatment of skin diseases, 529. 

Extract of cofi'ee, 505. 

Extracts ; from the bulletin of public health, 667 
284; ofwahoo bark, 418. 

Extraordinary complications in congenital her- 
nia, 231. 

Extra-uterine pregnancy, 52, 243, 372. 

Eye, some forms of afi'ections of the, resulting 
from reflex irritation, 199. 

Eyeball, rupture of the, 153. 

Eyes, how to care for the, 237. 

Face, eczema of the, 186. 

Facial nerve stretched, for convulsive tic, 83. 

Factor, mental, consciousness as a, 348. 

False ; labor, 153 ; joint, treated by Prof. Henry 
H. Smith's method, 460. 

Fatal ; poisoning by veratrum viride, 372 ; acci- 
dents from anesthetics prevented, 388 ; case 
of ovariotomy, 530. 

Fatty ; bodies, solubility of chloral in, 40 ; kid- 
ney, 342. 

Fauces, stenosis of the, 381. 

Features, clinical, of disseminated sclerosis, 141. 

Feeding ; improper, the cause of diarrhoea in art 
infant, 1 ; milk to infants, 344. 

Fees, medical, in Prussia, 395. 

Feet, oedema of the, in consumption, 430. 

Female ; bladder, excessive irritability of the,- 
treated by Teale's method, 471 ; assistants in 
insane hospitals, 546. 

Femoral, hernia, incarcerated, partially reduced 
by taxis, 383. 

Femur, excision of the head of the, for intracap- 
sular fracture, 188. 

Fever ; causes of heat in, 64 ; intermittent^ is it 
hereditary? 413; scarlet, the chlorine mixture 
in, 172 ; typhoid, an endemic of, from defect- 



ive drainage, 



elements of prognosis in, 



139 ; simulated by cirrhotic kidney, 362 ; rela- 
tion of sev/er gas to, 384 ; the fungus of, 387 ; 
identity of the poisons of scarlatina and, 392 ; 
cold water in, 408 ; treatment of, 498 ; yellow^ 
the contagion of, 41, 240, 305, 454 ; the cause 
of, 64 ; investigation of, 66, 130 ; introduction^ 
of, 85 ; symptoms, pathology and treatment of, 
269 ; threatenings of, 329, 395 ; on the steamer 
" Plymouth," 361 ; at Port-au-Prince, 504. 

Fevers, erythematous, use of belladonna in, 320, 

Fibro- cystic tumor of the uterus complicated 
with pregnancy, 427. 

Fibroid, uterine, ergotine suppositories in, 365. 

Filthy condition of New Orleans, 198. 

Filtration of rivers, 553. 

Fingers, swollen, suggestion for treating, 11. 

Fissure, anal, the importance and treatment of;. 
485. 

Fistula ; following empyema, 249 : perineal, with 
stricture, 249 ; vesico-vaginal, 447. 

Flap operation, antero-posterior, in amputation' 
of the thigh, 317. 

Flexible metallic bougie, 350. 

Floating kidney, intestinal obstruction from a, 502, 

Fluid extracts of wahoo bark, 418. 

'Fluids of the body, 525. 

Foetation, extra-uterine, 243. 

Foetus, the length of the, 217. 

Follicles, Graafian, developed during pregnancy ^ 
40. 



Inaex. 



IX 



Fomentations, warm, to the head, in cases of 
uterine hemorrhage, 278. 

'Food, objections to milk as, 453. 

Forced dilatation of the sphincter vesicae, 471. 

Forceps ; in midwifery, 3, 49, 213, 261 ; their 
use when the os uteri is partially dilated, 124, 
254. 

Forcible dilatation in irritable ulcer of the rec- 
tum, 526. 

Forearm, complete outward dislocation of the, 
250. 

Foreign bodies ; in the stomach, 153; removed 
from the ear and nose, 163, 195, 387 ; in the 
oesophagus, 250, 393. 

Form ; best, of mercury, for hypodermic use, 63; 
rare, of mammarj-^ tumor, 495 ; undescribed, 
of respiratory disease, 527 ; perilous, of men- 
tal effort, 545. 

Forms; of antagonism in drugs, 61 ; of the head, 
their significance, 194; of alcoholism, 524. 

Foundlings' turntable, 197. 

Fowls, diphtheria in, 326. 

Fracture ; of the handle of the malleus, in trau- 
matic perforation of the membrana tympani, 
161 ; of the lower end of the radius, the cause 
of deformity in, 166 ; intracapsular, excision 
of the head of the femur for, 188 ; of the lower 
jaw, 317 ; compound, of the left leg, 463 ; un- 
united, of the tibia, 471. 

France, the profession in, 217. 

Frequency of hepatic abscess, 171. 

Frostbite, 118. 

Fuchsin in albuminuria, 458. 

Functional disorders in digestion, 512. 

Fungus of typhoid fever, 387. 

Galvanism in the treatment of stricture and 
gleet, 360, 442. 

Gangrene, idiopathic, of the penis, 58 ; pul- 
monary, the sputum in, 545. 

Gargle, for angina, 217. 

Gas, sewer ; its relation to 'typhoid fever, 384 ; 
alleged blindness from, 549. 

Gastric digestion, 375, 507. 

Gastro ; -enteric dysentery, malignant, 12 ; -intes- 
tinal symptoms of the influenza epidemic, 208. 

General ; papular syphilide, 123 ; paralysis in 
women, 253 ; symptoms and treatment of 
surgical shock, 319 ; botany of the Pacific 
States, 500. 

German ; treatment of croup and diphtheria, 
12 ; medical staflP, its organization, 21. 

Germs of infectious diseases, demonstrations of, 
457. 

Giants' battle over evolution, 38. 

Give electric baths, how to, 101. 

Gland, vulvo-vaginal, cyst of, 426. 

Glanders, poisoning by, 524. 

Glands, enlarged, treatment of, 371. 

Gleet, treated with galvanism, 360, 442. 

Goitre ; exophthalmic, 211 ; treatment of, 409. 

Gonorrhceal epididymitis, 260. 

Gouty, diet of the, 80. 

Graafian follicles developed during pregnancy, 40. 

Graduates, lecture courses to, 219. 

Granular ; pharyngitis, chronic, 259 ; kidney, 
362. 

Gratifying change, 127. 

Great Britain ; the metric system in, 21 ; letters 
from, 502, 645. 



Gross banquet, proceedings of the, 394. 

Grounds of certainty in medical reasoning, 60. 

Growth of the metric system, 391. 

"Grub" in the head, 193. 

Gunshot wound ; of the heart, 188 ; involving 

the second dorsal vertebra, 228. 
Gurjun oil in leprosy, 370. 
Gynecological wire loop, 130. 

Habit, opium, cure of the, 525. 

Hematuria, 248. 

Haemoptysis, pyrogallic acid in, 83. 

Hair ; pin as the nucleus of a calculus vesicce, 10 ; 
restorative, a new, 326 ; removing, 552. 

Handle of the malleus fractured, in traumatic 
perforation of the membrana tympani, 161. 

Hands, chapped, recipe for, 347. 

Hanging, cause of death in, 195. 

Hard chancres, the excision of, 544. 

Head; eczema of the, 186; of the femur, its ex- 
cision, for intracapsular fracture, 188 ; ' ' grub' ' 
in the, 193 ; significance of forms of the, 194 ; 
eucalyptus in a cold in the, 238 ; warm foment- 
ations to the, in uterine hemorrhage, 278. 

Headache, hints for, 62, 101. 

Health; extracts from the bulletin of, 66, 220, 
417, 440, 505, 549; resorts; in Egypt, 106; 
notes on, 131 ; board, national, organized, 
329 ; resolutions, in Philadelphia, 373 ; North 
Carolina State Board of, 373 ; is much bathing 
conducive to, 478. 

Hearn's ether inhaler, 505. 

Heart ; disease ; digitalis in, 57 ; hereditary trans- 
mission of, 127 ; chloroform in, 277 ; arsenic 
in, 282 ; its state as an element of prognosis 
in typhoid fever, 139 ; gunshot wound of the, 
188 ; singular wounds of the, 540. 

Heat, causes of, in fever, 64. 

Hematemesis, its management, 185. 

Hemiplegia, apoplexy with, 77. 

Hemorrhage ; post-partum, concealed, causes of, 
28 ; treatment of, 133 ; remote results of, 388 j 
uterine, warm fomentations to the head in, 
278 ; internal, acetate of lead in, 501'. 

Hemorrhoids, physiological cure of, 136. 

Hepatic ; abscess ; is it safe to puncture in, 17, 
89; its frequency, 171; cases of, 251; con- 
cealed, 369 ; the antiseptic treatment of, 519. 

Hereditary ; transmission of heart disease, 127 ; 
descent of disease, 155 ; predisposition to 
mania, 404; malarial poisoning, 526. 

Hermaphroditism, 524. 

Hernia ; congenital, 231 ; umbilical, 246 ; incar- 
cerated femoral, partially reduced by taxis, 
383 ; strangulated, treated by ergotine, 388. 

Herpes zoster, 186. 

Pliccup, remedies for, 238, 417. 

Hints ; on the progress of otology, for 1878, 45, 
67 ; for headaches, 62. 

History, natural, of naso-pharyngeal polyps, 
252. 

Homoeopathic statistics, 329. 

Horsford's acid phosphate, 505. 

Hospital, private. Burn Brae, a, 549. 

Hospital Reports — 

College of Physicians and Surgeons, Baltimore 

Clinic of Prof. A. B. Arnold, 403. 
College of Physicians and Surgeons, New York 
Clinic of Prof. T. Gaillard Thomas, 424, 444. 
German Eye and Ear Infirmary, 175 — 



Index. 



Hospital of the University of Pennsylvania — 

Clinic of Prof. Wm. Pepper, 8. 
Howard Hospital^ Philadelphia — 

Clinic of Dr. Chas. S. Turnbull, 161. 
Jefferson Medical College Hospital — 
Clinic of Prof. S. D. Gross, 247. 
Clinic of Dr. John H. Brinton, 468. 
Kings Co. Hospital, Flatbush, L. I— 

Service of J. C. Hutchinson, m.d., 230. 
Long Island College Hospital, Brooklyn — 
Report by House Physician Winfred Wylie, 

31, 250. 
Service of Dr. Burge, 231. 
Medical Department of the University of the 
City of New York — 
Clinic of Prof. Wm. A. Hammond, 30. 
Neio York Hospital — 

Clinic of L. Duncan Bulkley, m.d., 121, 142, 
186. 
Pennsylvania Hospital — 

Clinic of Prof. Da Costa, 75, 133, 182, 208. 

339, 361. 
Clinic of Dr. R. J. Levis, 273, 317, 381. 
Philadelphia Hospital — 

Clinic of Dr. John H. Brinton, 53, 94, 118. 
Hospitals, insane ; statistics of, 457 ; female as- 
sistants in, 546. 
Hot water douche in diarrhoea, 433. 
How ; to give electric baths, 101 ; to care for the 

eyes, 237 ; to measure a skull, 454. 
Human ; parasites derived from eating fish, 19 ; 
mortality, premature, 70; bladder, inversion 
of the, 91, 115. 
Hydrophobia ; the nature of 453 ; a case of, 

479. . 
Hyperaesthesia, hysterical, treated by metallo- 

scopy, 265. 
Hypodermic use ; of mercury, the best form for, 
63 ; of morphia in convulsions from reflex irri- 
tation, 218 ; of quinine, 277 ; medication, 349 ; 
injection of tartrate of morphia, 365. 
Hypothetical case of alleged poisonous dose of 
tincture veratrum viride, with its ethical bear- 
ing, 238. 
Hysterical ; cough, pathology of, 42 ; hyperees- 
thesia treated by metalloscopy, 265. 

Ice treatment of pseudo-membranous or true 

croup, in children, and acute laryngitis in the 

adult, 151. 
Identity of the poisons of scarlatina and typhoid 

fever, 392. 
Idiopathic ; gangrene of the penis, 58 ; ery- 
sipelas, and some of its clinical concomitants, 

287. 
Illustration of the use of koumiss, 406. 
Immense ; abscess, following empyema, 249 ; 

abdominal tumor, 405. 
Impacted urethral calculus, 539. 
Importance of anal fissure, 485. 
Impostors, beware of, 86. 
Improper feeding a cause of malnutrition and 

diarrhoea in an infant, 1. 
Incarcerated femoral hernia partially reduced by 

taxis, 383. 
Incontinence of urine ; in children, 190, 410 ; 

Teale's method of forced dilatation in, 471. 
Increase ; of insanity, 348 ; of physical evil, 

456. 
Index ; medicus, the, 66 ; rerum, 264. 



Induced, or symmetrical anaesthesia, 128. 

Inebriety ; peculiarities of, 61 ; clinical studies 
of, 72. 

Indiana, the medical law of, 328, 395. 

India-rubber bandage, solid, 369. 

Infant ; malnutrition and diarrhoea in, from im- 
proper feeding, 1 ; the largest on record, 308. 

Infantile ; urticaria, 122 ; diarrhoea, koumiss 
in, 365 ; paralysis, treatment of, 387. 

Infants ; verminal leucorrhoea in, 172 ; chloro- 
form in convulsions of, 336 ; milk feeding of^ 
344. 

Infection, syphilitic, two results of, 381. 

Infectious diseases, demonstration of the germs 
of, 457. 

Inflammation, uterine, positional treatment of, 
11. 

Influence ; of uterine disease on nervous dis- 
orders, 63 ; of lung complication on the ques- 
tion of aspiration in chronic pleurisy with efltu- 
sion, 138. 

Influenza, an epidemic of, 208, 349. _ 

Inhalation of oxygen for albuminuria, 454. 

Inhaler of ether, Dr. Hearn's, 505. 

Injections ; of tannic and salicylic acids into the 
bladder, for cystitis, with retention of urine. 
283 ; hypodermic, of tartrate of morphia, 
365 ; carbolic, for piles, 458. 

Injuries ; of the membrana tympani, 161 ; rail- 
road, 540. 

Injury ; to the sight, removal of epithelioma^ of 
conjunctiva without, 188 ; gunshot, involving 
the second dorsal vertebra, 228. 

Insane hospitals ; statistics of, 457 ; female as- 
sistants in, 546. 

Insanity, suicide and, 62 ; relations of occupa- 
tion to, 253 ; is it increasing, 348 ; cases of,. 
403 ; physicians' certificates of, 462. 

Instance of false, or simulated labor, 153 ; of 
latent syphilis, 189. 

Instrumental interference in uterine displace- 
ments, 180. 

Instruments in labor, 85. 

Intemperance ; its effects on posterity, 156 ; al- 
leged cure for, 282. 

Interesting case in ophthalmic diagnosis, 195. 

Interference, instrumental, in uterine displace- 
ments, 180. 

Intermarriage of relatives, 156. 

Intermittent; albuminuria of adolescents, chronic- 
123; broncho -pneumonia, 387; fever, is it he- 
reditary? 413. 

Internal ; medication for the absorption of cata- 
ract, 388 ; aneurism, 451 ; hemorrhage, acetate 
of lead in, 501. 

Interstitial nephritis, 362. 

Intestinal obstruction from a floating kidney, 502. 

Intracapsular fracture, excision of the head of 
the femur for, 188. 

Introduction of yellow fever, 85. 

Inventions, recent, applied to medicine, 501. 

Inversion of the human bladder, 91, 115. 

Inverted toe nail, 527. 

Investigation of the yellow fever, 66, 130. 

Involvement ; of the aorta in gunshot wound of 
heart, 188 ; of the second dorsal vertebra in 
gunshot injury, 228. 

Iodide of potassium ; in apoplexy, with hemi- 
plegia and syphilitic brain disease, 77 ; and 
aconite in thoracic aneurism, 275. 



Index, 



XI 



Iodoform as a local anajsthetir-, 12. 

Irish potatoes and diphtheria, 283. 

Iron ; non-oxydizable, 18 ; ergot and, in albu- 
minuria, 210 ; as a blood enricher, 433 ; dia- 
lysed, an antidote to arsenic, 434. 

Irritable; bladder, 248 ; treated by Teale's 
method of forced dilatation, 471 ; stomach, 
tincture of walnuts in, 259 ; ulcer of the rec- 
tum treated by forcible dilatation, 526. 

Irritation ; reflex ; affections of the eye resulting 
from, 199 ; value of morphia hypodermically 
in convulsions from, 218; of the sympathetic 
through the pharynx, 430. 

Is it safe to puncture in hepatic abscess? 17. 

Issues which imperil the principles and practice 
of modern lithotrity, 23. 

Italy, the climate of, 198. 

Jaborandi ; its success in dropsy, 210 ; in albu- 
minuria of pregnancy, 326 ; in night sweats, 
434. 

Jaundice, copaiba in, 33. 

Jaw, lower, fracture of the 317. 

Joint ; knee, crepitation in, in rachitis, 1 ; el- 
bow, crushed, 320 ; false, treated by Prof. 
Henry H. Smith's method, 460. 

Joints, resection of several, in the same indi- 



Kansas medical act, 172, 503. 

Kidney; fatty, 342; contracted, 362; albumi- 
noid, 362 ; floating, intestinal obstruction from 
a, 502. 

Knee joint, crepitation in the, in rachitis, 1 ; re- 
section of the, 105. 

Koumiss ; in infantile diarrhoea, 365 ; use of, 
406. . 

Labor ; use of chloroform in, 32 ; instruments 
in, 85, 213 ; simulated, 153 ; pains, morphia in, 
326 ; a twin, with breech and shoulder pre- 
sentation, 327 ; placenta previa, peculiarities 
of the third stage in ; 343 ; digital dilatation 
of the OS in, 409. 

Laceration ; of the cervix, 428 ; of the urethra, 463. 

Lactopeptine, 505. • 

Land scurvy, 351. 

Langenbeck's operation for cleft palate, 190. 

Laparotomy, adeno- sarcoma of the ovary re- 
moved by, 424. 

Large ; doses of capsicum, their action, 124 ; 
prize, 479. 

Largest infant on record, 308. 

Laryngitis, acute, in the adult, ice treatment of, 
151. 

Late ; discoveries regarding the nature of con- 
tagion, 104; Dr. G. B. Wood, 329; sugges- 
tions on ozgena, 408. 

Latent syphilis, an instance of, 189. 

Lateral lithotomy, 469. 

Law.; of average in suicides, 237 ; medical, of 
Indiana, 328. 

Laws of therapeutics, 106. 

Laxative, dangers in the use of calcined magnesia 
as a, 129. 

Lead ; pialsy, the magnet in, 366 ; acetate of, in 
internal hemorrhage, 501. 

Lectures ; on dermatology, at the University of 
Pennsylvania, 20 ; to graduates, 219 ; on report- 
ing, 479. 



Left ovary, prolapse of, 444. 
Leg; results of an amputation of the, 319; com- 
pound fracture of the, with complications, 

463. 
Legal relations of color blindness, 504. 
Legislation, medical, in Michigan, 286. 
Legs ; oedema of, in consumption, 430 ; bow, 

management of, 458. 
Length of the foetus, 217. 
Leonurus cardiacain asthma, 152. 
Leprosy; angesthetic, nerve stretching in, 256; 

gurjun oil in, 370. 
Let us have truth, 498. 
Letters from Europe, 502, 545. 
Leucorrhoea, verminal, of infants, 172. 
Levis' operation for varicocele, 382. 
Liability of fracture of the lower jaw to occur in 

one place, 317. 
Life; civil, scurvy, in 75 ;' insurance companies 

and physicians, 523. 
Ligation, subcutaneous, for varicocele, 382. 
Lithotomy, 468, 469. 
Lithotrity, modern, recent issues by which its 

principles and practice are imperiled, 23. 
Liver ; action of remedies on the, 342 ; abscess 

of the, opening through the lungs, 459. 
Local ; anaesthetic, iodoform as a, 12 ; use of 

quinine in pannus, 347 ; use of chloral in 

diphtheria, 533. 
Locomotor ataxia; Westfield's diagnostic point 

in, 18; simulated by syphilis, 452. 
London ; vital statistics of, 110 ; cremation in, 

154. ^ 
Longevity of Quakers, 237. 
Long standing necrosis, amputation of the thigh 

for, 317. 
Loop, wire, for gynecological use, 130. 
Lower ; end of the radius, cause of deformity in 

fracture of the, 166; animals, relation of their 

diseases to those of man, 235 ; jaw, fracture of 

the, 317. 
Lunacy, treatment of, 83. 
Lung complication, its influence on the question 

of aspiration in the effusion of pleurisy, 138. 
Lungs ; tapping the, in phthisis, 10 ; abscess of 

liver opening through the, 459. 
Lupus ; surgical treatment of, 33, 107. 

Madame Anderson's walk, 87. 

'' Mad stone," value of a, 109. 

Magnesia, calcined, dangers of its use as a laxa- 
tive, 129. 

Magnet, in lead palsy, 366. 

Malarial; diseases, Warburg's tincture in, 255; 
carbolic acid in, 553 ; poif oning, hereditary, 526. 

Malignant; gastro-enteric dysentery, 12; pustule, 
experiments on, 144. 

Malleus, fracture of the handle of the, 161. 

Malnutrition and diarrhoea in an infant, from 
improper feeding, 1. . • 

Malpractice, suits for, 197. 

Maltine, 86. 

Mammary tumor, rare form of, 459. 

Man, diseases of the lower animals in their rela- 
tion to the diseases of, 235. 

Management; of puerperal convulsions, 107 ; of 
hematemesis, 185 ; of bow legs, 458. 

Mania ; acute, 404 ; puerperal, treatment of, 
498. 

Materia medica and therapeutics, newly elected 



Xll 



Index, 



professor of, at the Jefferson Medical College, 
284. 

Matter, new, in physiology, 396. 

Mead in wasting diseases, 370. 

Means ; pleasant, of medication, 393 ; of disin- 
fection, 462. 

Measles, cool air and water treatment of, 414.' 

Measure, operative, for the arrest of commencing 

S fpyasmia, 166. 

Measurement of a skull, 454. 

Measures, English, for controlling prostitution, 
522. 

Mechanical ; appliances avoided in after treat- 
ment of operation for equino- varus, 384; 
treatment of spasmodic dysmenorrhoea, 474. 

Medical ; testimony, 7 ; staff of Germany, 21 ; 
of the Russian army, 131 ; reasoning, the 
grounds of certainty in, 60; charities, of Phil- 
adelphia, 86 ; act for Kansas, 172 ; for Wis- 
consin, 307 ; education before entering and 
after leaving college, 259 ; legislation in Mich- 
igan, 286 ; delusions, 294 ; law of Indiana, 
328 ; uses of nitro-glycerine, 389 ; college of 
Arkansas, 395 ; bill, in Indiana, 395 ; fees in 
Prussia, 395 ; men in Russia, 411 ; botany of 
the Pacific states, 500 ; use of cinchona, 520. 

Medical Societies — 

American Association for the Cure of Ine- 
briates, 516. 
American Laryngological Society, 554. 
American Medical Association, 435, 448. 
Arkansas State Medical Society, 534. 
Association of American Medical Colleges, 

437. 
Association of American Medical Editors, 440. 
College of Physicians, Philadelphia 97, 251, 

384, 405, 471. 
Convention of American Medical Colleges, 
^436. 

Kansas State Medical Society, 518. 
National Board of Health, 438. 
New 'York Academy of Medicine — officers 

elect, 43. 
New York Neurological Sgciety, 188. 
New York Pathological Society, 188. 
New York State Medical Society — annual 

meeting, 163. 
Northern Medical Society of Philadelphia, 497. 
Pennsylvania Medical Society, thirtieth an- 
nual meeting, 480, 489. 
Philadelphia County Medical Society — officers 

elect, 109, 296. 
PJiode Island State Medical Society, 56, 296. 



Medication ; hypodermic, 349 



internal, for the 
pleasant means 



absorption of cataract, 
of 393 

Medicinal agents, sea weeds as, 501. 

Medicine ; state, in Pennsylvania, 66 ; as prac- 
ticed by the aboriginal races of the southwest, 
157 ; petroleum and its derivatives in, 324 ; 
application of recent inventions to, 501 ; law 
of Kansas, 503. 

Melancholia, with suicidal propensity, 403. 

Membrana tympani ; diseases of the 67 ; perfo- 
rating wounds and injuries of the, 161. 

Menibranous croup, tracheotomy in, 277. 

Meningitis; spinal, followed by disseminated 
sclerosis, 141 ; treated by the cold douche, 
536; 

?*[enstruation during pregnancy, 304. 



Mental ; strain, physical disease resulting from, 
271 ; factor, consciousness as a, 348 ; effort, a 
perilous form of, 545. 

Mercury, the best form of, for hypodermic use, 
63. 

Metallic bougie, flexible, 350. 

Metalloscopy, experiments in, 370. 

Metallo-therapy ; the secret of, 195 ; in hysteri- 
cal hypergesthesia, 265. 

Meteorology and epidemics, 338. 

Method; Aveling's, of transfusion of blood, 230; 
of reducing a retroflected uterus, 414 ; Prof. 
Henry H. Smith's, of treating false joint, 460 : 
Teale's, of forced dilatation, 471 ; of removing 
hairs, 552. 

Metric system; in Grreat Britain, 21; in this 
country, 219 : its growth and worth, 391. 

Metritis, chronic, surgical treatment of, 254. 

Michigan, medical legislation in, 286. 

Microphone in diagnosis, 84. 

Midwifery, the forceps in, 3, 49, 267, 291. 

Migraine, chloral in, 63. 

Mild scarlatina, diagnosis between erythema and 
452. 

Milk ; transfusion of, 230 ; feeding, of infants, 
344 ; diet in dysentery, 347 ; as food, objec- 
tions to, 453 ; deficient secretion of, 525. 

Milkmen, syphilitic, 151. 

Mind, effects of chronic starvation on the, 63. 

Minimizing the dangers of anaesthetics, 194. 

Mirror, a new electric, 545. 

Mississippi, pneumonia in, 434. 

Mixture, chlorine, in scarlet fever and diph- 
theria, 172. 

Mode ; of diagnosis, percussion of the skull as a, 
213 ; of dressing and cleaning the stump in 
amputation, 319; of after treatment in opera- 
tion for equino-varus, without mechanical ap- 
pliances, 384. 

Modern lithotrity, recent issues by which its 
principles and practice are imperiled, 23. 

Mole, 247. 

Molluscum contagiosum, 83. 

Monobromide of camphor an antidote to strych- 
nia, 18. 

Monster; a curious, 21 ; an'anencephalus, 152. 

Morbid softness of the uterus, 321. 

Morbus coxarius, 453. 

Morphia ; its hypodermic use in convulsions 
from reflex irritation, 218 ; in labor pains, 326 ; 
tartrate of, for hypodermic injection, 365. 

Mortality ; from alcohol and other causes, 40 ; 
human, premature, 70 ; of the influenza epi- 
demic, 208 ; the causes of, 221 ; of either sex, 
353. 

Mother, relation between the age of the, and the 
sex of the child, 304. 

Mouth ; chromic acid in affections of the, 478 : 
cysts of the, 539. 

Much bathing, is it healthful? 478. 

Multiple or disseminated sclerosis following 
spinal meningitis, 141, 357. 

Mumps, their nature, 193. 

Muscles, cramp of the, 245. 

Muscular atrophy, progressive, its pathology, 189. 

Mydriasis, treatment of, 538. 

Myocarditis, the diagnosis of, 278. 

Nffivus; the croton-oil treatment of, 128: can- 
tharidine in, 326. 



Index. 



XllI 



Naplithaline in catarrh, 326. 

Naso-phaiyngeal polyps, natural history of, 252. 

National board of health organized, 329. 

Nature ; and treatment of acne, 79 ; of con- 
tagion, late discoveries regarding the, 104 ; of 
mumps, 193 ; of hydrophobia, 453. 

Necessary conditions for contagion to spread, 58. 

Neck, congenital sinus from the pharynx to the 
surface of the, 247. 

Necrosis, long standing, amputation of the thigh 
for the relief of, 317. 

Neglected ; proximate cause of dyspepsia, 238 ; 
sanitary precautions in southern cities, 411. 

Nephritis ; acute, 31, 339 ; chronic tubal, 210, 
298, 340 ; interstitial, 362. 

Nerve ; facial, stretched, for convulsive tic, 
83 ; stretching in anaesthetic leprosy, 255 ; 
in tetanus, 297. 

Nerves, the suture of, 343. 

Nervous : disorders, influence of uterine disease 
on, 63 ; symptoms of the influenza epidemic, 
208. 

Neurasthenia, 397, 419. 

New ; year, and its duties, 16 ; York city, vital 
statistics of, in 1878, 43 ; Orleans, the filthy 
condition of, 198 ; hair restorative, 326 ; 
remedy in dysentery, 347 : tasteless purgative, 
349 ; matter in physiology, 396 ; method oif 
reducing a retroflected uterus, 414 ; -old 
remedy for rheumatism, 501 ; experiments in 
anaesthetics, 537 ; electric mirror, 545. 

Nice, the truth about the climate of, 544. 

Night ; cough, 408 ; sweats, jaborandi in, 434. 

Nitre, poisoning from sweet spirits of, 102. 

Nitro-glycerine, medical uses of, 389. 

Nitrous oxide in asthma, 431. 

Non-oxydizable iron, 18. 

North Carolina State bof 

Nose, removal of foreign bodies from the, 387. 

Notes ; of three cases of hepatic abscess, 89 ; on 
health resorts, 131 ; of a case of confinement, 
370. 

Novel ; pharmaceutical preparations, 86, 307, 
329 ; partnership, 395. 

Nucleus of a calculus vesicae, a hair pin as a, 10. 

Nutritive enemata, value of, 412. 

Obituary notices ; Drs. Farner, Rauschenberg, 
Vedder, Millinger, Riecker, Jones, 21 ; Drs. 
Scott, Brooks, Bonner, Quin, Atlee, 44 ; Dr. 
Crispell, 66; Drs. John B. Biddle, A. W. 
Lueck, 87 ; Drs. Jacob Bigelow, W. T. Nealis, 
110 ; Drs. Nathan Mitchell, Tardieu, S. H. 
Shannon, 131 ; Dr. Taylor Vance Thompson, 
176 ; Dr. W. M. Fitch, 198 ; Drs. John Hugh 
McQuillen, H. 0. Wilson, 241 ; Drs. John M. 
Woodworth, Willis E. Sutton, Daniel S. Cor- 
liss, Randolph Marshall, Sr., 264; Dr. Moses 
Brownell, 286 ; Drs. Geo. B. Wood, Horace 
Binney Hare, J. W. McGuire, 308; Drs. 
Isaac Hays, J. C. Riley, 352 ; Drs. Charles F. 
Deshler, Charles L. Ives, John J. Wilson, 
374; Drs. Thos. J. Corson, 0. A. Carroll, 
Robert J. Whitely, Jos. P. Chandler, 462; 
Drs. Isaac Thomas, Chas. Murchison, H. W. 
Dove, Gubler, 484; Drs. John McCulloch, 
Chas. Skelton, 506 ; Dr. Francis Fontaine 
Maury, 528, 550 ; Drs. John T. Darby, Jacob 
F. Treichler, D.W. Putnam, Peregrine Wroth, 
-554. 



Objections ; religious, to anaesthesia, 304 ; to 
milk as food, 453. 

Obscure pulmonary disease, 316. 

Observations ; on affections of the eye from re- 
flex irritation, 199 ; on the treatment and pro- 
phylaxis of scarlatina, 205. 

Obstetric forceps, the use and abuse of, 261. 

Obstetrics, quinia in, 282. 

Obstinate psoriasis, treatment of, 298. 

Obstruction ; acute, of the bowels, treatment of 
298 : intestinal, from a floating kidney, 502. 

Occupation, relations of, to insanity, 253. 

CEdema of the feet and legs in consumption, 
430. 

QEsophagus, foreign body in the, 250, 393. 

Oil; croton, treatment of nag\nis with, 12S ; gur- 
jun, in leprosy, 370. 

Oleate of zinc, 64, 478. 

Olfactory, apparatus, comparative anatomy of 
the, 348. 

One hundred and two years old, 88. 

Onychia, syphilitic, 122. 

Opening ; spontaneous, in empyema, 249 ; of 
abscess of liver through the lungs, 459. 

Open wounds, reunion of divided tendons in, 
223. 

Operation ; Langenbeck's, for cleft palate, 190 ; 
antero-posterior flap, in amputation of the 
thigh, 317 ; for stenosis, 381 ; Dr. Levis's ; for 
varicocele, 382 ; for equino- varus, after treat- 
ment in, without mechanical appliances, 384. 

Operations, vomiting after, 34. 

Operative measures for the arrest of commenc- 
ing pyaemia, 166. 

Ophthalmia ; acute, ergotine in, 34 ; sympa- 
thetic, 225; neonatorum, 392. 

Ophthalmic diagnosis, 175. 

Opium smoking ; eff"ects of, 260 ; the cure of 
525. _ 

Organization ; of the German medical staff, 21 ; 
of thrombus, 167. 

Organs of circulation, effects of quinine on the, 
430. 

Os uteri ; use of the forceps when it is partially 
dilated, 254 ; dilatation of the, for sterility, 
344 ; in labor, 409. 

Otalgia intermittens, 68. 

Otitis intermittens, 68. 

Otology, its progress in 1878, 45, 67. 

Outward dislocation of the forearm, complete, 
250. 

Ovarian pain in pregnant women, 540. 

Ovariotomy, 272, 441, 530, 553. 

Ovaritis, chronic, its treatment, 497. 

Ovary ; cysto-sarcoma of, 109 ; adeno-sarcoma 
of 424 ; prolapse of, 444. 

Oxide, nitrous, in asthma, 431. 

Oxygen ; therapeutic value of, 145 ; in albumin- 
uria, 238, 454 ; in the treatment of rabies, 433. 

Oxyurides, eczema, produced by, 62. 

Ozeena, late suggestions on, 408. 

Pacific states, medical and general botany of the, 

600. 
Pain, from the application of sulphate of copper, 

relief of, 195. 
Pains of labor, morphia in, 326. 
Palate, cleft, Langenbeck's operation for, 190. 
Palmetto berries, their uses, 525. • 

Palsy, lead, the magnet in, 366. 



XIV 



Index* 



Pannus, quinine locally in, 347. 

Paper, waterproof, 331. 

Papular sypliilides, 123. 

Paralysis ; ephemeral, of babies, 194 ; general, 
in women, 253 ; agitans, 357 ; infantile, treat- 
ment of, 387. 

Paraplegia from spinal sprain, treated by the 
actual cautery, 274. 

Parasites, human, derived from eating fish, 19. 

Paris exhibition, the anthropological section of 
the, 20. 

Partial ; dilation of the os uteri, use of the for- 
ceps in, 124; reduction of incarcerated femoral 
hernia, by taxis, 383. 

Partnership, a novel, 395. 

Pasteboard splint, in treatment of fracture of the 
lower jaw, 317. 

Patents as applied to pharmaceuticals, 215. 

Pathology ; of diphtheria, 40 ; of hysterical 
cough, 42 ; of progressive muscular atrophy, 
189; of yellow fever, 269; of tetanus, 412. 

Peculiarities ; of inebriety, 61 ; of the third 
stage in placenta prsevia labors, 343, 

Penis, idiopathic gangrene of the, 58. 

Pennsylvania ; lectures on dermatology at the 
University of, 20 ; state medicine in, 66. 

Pepsin, vegetable, 413. 

Percussion of the skull as a mode of diagnosis, 
213. 

Perilous form of mental eflfbrt, 545. 

Peritonitis and pleurisy, with cirrhotic kidney, 
simulating typhoid fever, 362. 

Perforating wounds of the membrana tympani, 
161. * 

Perineal fistulas, with stricture, 249. 

Perineum, subinvolution of the, 428. 

Permanent fistula following empyema, 249. 

Personal similarities and dissimilarities, 260. 

Persistent vomiting in young women, its signifi- 
cance and rational treatment, 184. 

Peru, balsam of, in wounds, 370. 

Personal items, 66, 131, 176, 198. 

Pertussis, atomized ether in, 325. 

Pessary, rubber ball, 108. 

Petroleum and its derivatives in pharmacy and 
medicine, 324. 

Pharmaceutical preparations ; novel, 86, 307 ; 
patents, trademarks and copyrights, as applied 
to, 216. 

Pharmacopoeia convention, sixth decennial, 394. 

Pharmacy ; petroleum and its derivatives in, 324; 
novelties in, rubber plasters, 329. 

Pharyngitis, chronic granular, formula for, 259. 

Pharynx; congenital sinus from the, 247 ; irri- 
tation of the sympathetic through the, 430. 

Phenomena, characteristic, of the influenza epi- 
demic, 208. 

Phenomenon in reproduction, 286. 

Philadelphia, medical charities of, 86. 

Phlegmon in Douglas' cul-de-sac, 427. 

Phosphate, Horsford's acid, 505, 

Phthisis ; the solfatara treatment of, 2 ; tapping 
the lungs in, 10 ; thoracentesis in, 57 ; alcohol 
and, 194 ; relief of cough in, 304 ; effects of 
climate in, 392 ; effects of elevated regions on, 
540. 

Physical ; disease resulting from mental strain, 
271 ; evil, the increase of, 456. 

Phjpsicians ; certificates of insanity by, 462 ; life 
insurance companies and, 523. 



Physics of emulsifying, 392. 

Physiological ; action of coffee, 40 : cure of hem- 
orrhoids, 136 ; consideration of functional dis- 
orders in digestion, 512, 

Physiology ; of an easy chair, 63 ; of the salivary 
secretions, 111, 309 ; of conception, 349 ; new 
matter in, 396, experimental 111, 309, 376. 
507. 

Piles treated by carbolic injections, 458. 

Pilocarpin ; as an abortifacient, 127 ; in syphilis^ 
637, 

Placenta ; retained, 129 ; praevia labors, pe- 
culiarities of the third stage in, 343 ; posture 
in expulsion of the, 553, 

Plagiarism discovered, 369. 

Plague ; in Europe, 110, 149, 219, 285, 527 ; pre- 
cautions against the, 241, 307, 346, 

Plantation of the eucalyptus, extension of the» 
281. 

Plants, analogies between animals and, 217. 

Plasters, rubber, 329, 

Pleasant means of medication, 393. 

Pleurisy, chronic, with effusion, 138. 

Pleuritic signs simulated by worms, 326. 

Pleuro-pueumonia of cattle, 415. 

" Plj^mouth," the U.S. steamer, yellow fever on, 
351, 

Pneumonia ; caseous, 32 ; in Mississippi, 434, 

Pneumothorax following empyema, 249, 

Point, Westphal's diagnostic, in locomotor 
ataxia, 18, 

Poison ; of diphtheria, antagonism of alcohol to 
the, 128 ; diphtheritic, source of the, 192, 

Poisons of scarlatina and typhoid fever, their 
identity, 392. 

Poisoning ; from sweet spirits of nitre, 102 ; by 
chlorate of potash, 150; by veratrum viride, 
372, 457 ; by glanders, 524 ; hereditary ma- 
larial, 626; by stramonium, 648, 

Poisonous ; dose of veratrum viride, alleged^ 
238, 306 ; dyes, 624. 

Poisons, differences between zymotic and septic. 
34. 

Polyps, naso- pharyngeal, natural history of, 252, 

Popliteal aneurism, Esmarch's bandages in, 145. 

Pork, American, trichina in, 107. 

Port-au-Prince, yellow fever at, 504, 

Positional treatment of uterine inflammation, 11. 

Post-mortem emphysema, 100, 

Post-partum hemorrhage ; concealed, the causes 
of 28 ; treatment of, 133 : remote results of, 
388. 

Potash ; poisoning by chlorate of, 160 ; dangers 
of chlorate of, 349, 

Potassa, acetate of, 65. 

Potassium ; iodide of, in apoplexy 77 ; in tho- 
racic aneurism, 275 ; ethylate of, 80 ; bromide 
of, in croup, 433. 

Potato eating and diphtheria, 61, 150, 283. 

Poultices in rheumatic arthritis, 165. 

Practice of medicine and surgery by the aborigi- 
nal races of the southwest, 157, 

Practical diet table for diabetics, 233, 

Practitioner, country, advantages of the, 466, 

Precautions : against the plague, 241, 307 ; san- 
itary, neglected in southern cities, 411 ; in an- 
aesthesia, 458, 

Pregnancy ; development of the Graafian folli- 
cles during, 40 ; extra-uterine, 52, 372 ; men- 
struation during, 304 ; albuminuria of, treated 



Index. 



XV 



by jaborandij 326; complicated by fibro- cystic 
tumor of the uterus. 427 : the vomiting of, 525; 
ovarian pain in, 5-40. 

Predisposition, hereditary, to acute mania, 40-i. 

Premature human mortality, 70. 

Preparations ; novel, in pharmacy, 86 : cosmetic, 
169. 

Prescriptions, ready-made, 547. 

Presentation of breech and shoulder in twin 
labor, 327. 

Prevailing epidemic of influenza. 208. 

Prevalence of diphtheria. 88. 

Prevalent species of tapeworm. 62. 

Prevention: of consumption. 108: of self abuse, 
345 : of fatal accidents from using anesthetics, 
388 : of contagious diseases in schools, 552. 

Principles and practice of modern lithotrity. and 
the recent issues bv which thev are imperiled. 
23. 

Private hospital. Burn Brae, 549. 

Prize, a large. 479. 

Proceedings of the Gross banquet, 394. 

Production : of eczema by oxyurides, 62 ; of ab- 
sorption of cataract by internal medication, 
388. 

Profession, the, in France, 317. 

Prof. Henrv H. Smith's method of treating false 
joint, 460". 

Professorship of Materia Medica and Therapeu- 
tics at the Jefferson, 284. 

Prognosis, in typhoid fever, albuminuria and the 
state of the heart as elements of, 139. 

Progress ; of otology for 1878, 45, 67 ; of crema- 
tion, 280; of epidemics, 372; of therapeutics, 
458. 

Progressive muscular atrophy, the pathology of, 
189. 

Prolapse of left ovary. 444. 

Prolonged daily use of salicylic acid, 84. 

Propensity to suicide, in melancholia, 403. 

Prophylaxis of scarlatina, 205. 

Prostitution, English measures for controlling. 
522. 

Providence, statistics of, 44. 

Proximate cause of dyspepsia, 233. 

Prussia, medical fees in, 395. 

Pseudo-membranous croup in children, ice treat- 
ment of, 151. 

Psoriasis, 121 ; obstinate, treatment of 298 : py- 
rogallic acid in. 304. 

Pubic peritonitis, 427. 

Public health bulletin, extracts from. 66. 220, 
417, 440, 549. 

Puerperal; convulsions, 42. 107, 171. 306, 327, 
443 : mania, treatment of. 498. 

Pulmonary : symptoms in the epidemic of influ- 
enza, 208 ; disease, obscure, an epidemic of, 
316: type of, 394; gangrene, the sputum in, 
545. 

Pulse, in different races. 458. 

Puncturing in hepatic abscess, is it safe ? 17. 

Purgative, a new. tasteless, 349. 

Purpura : hemorrhagica equina, 327 ; or land 
scurvy, 351. 

Pustule, malignant, experiments on. 144. 

Pvffimia. an operative measure for the arrest of, 
166. 

Pyloric orifice, stricture of the. 460. 

Pvrogallic acid : in haemoptvsis, 83 : in psoriasis. 
304. 



I Quakers, longevity of, 237. 

I Quarantine : and the plague, 346 ; the questiorr 
of, 543. 

I Question of aspiration in the effusion of pleurisy 

I complicated with phthisis, 138. 

; Quick consumption, 32. 
Quinine ; rash, 84 ; hypodermic use of, 277 ; the- 
amount used, 281 ; in obstetrics, 282 ; locally^ 
in pannus, 346 ; action of, 350 ; its effects on 
the organs of circulation, 430 ; the duty on. 
462, 505. 

Rabies treated by oxygen, 433. 

Races ; aborginal, of the southwest, practice of 
medicine and surgery by the, 157 ; different^, 
the pulse in, 458. 

Rachitis ; with crepitation in the knee joint, 1 ;; 
symptoms of, 8. 

Radius ; the cause of deformity in fracture of the 
lower end of the, 166 ; fracture of the base of 
the, 463. 

Railroad injuries, 540. 

Rapid recovery from apoplexy, with hemiplegia 
and syphilitic brain disease, under iodide of 
potassium, 79. 

Rare form of mammary tumor, 459. 

Rash of quinine, 84. 

Rational treatment; of typhoid fever, 139; of 
persistent vomiting in young women, 184. 

Ready-made prescriptions, 547. 

Reasoning, medical, grounds of certainty in, 60,- 

Recent ; issues by which the principles and prac- 
tice of modern lithotrity are imperiled, 23 ; 
pubic peritonitis, phlegmon in Douglas' cul-de- 
sac from, 427 ; inventions applied to medicine^ 
501. 

Recovery ; from syphilitic brain disease, under 
iodide of potassium, 77 : from gunshot wound 
of the heart involving the aorta, 188. 

Rectum, irritable ulcer of the, treated by forcible- 
dilatation, 526. 

Reduction : partial, of incarcerated femoral her- 
nia, by taxis, 383 ; of a retroflected uterus^ 
414. 

Reflex irritation ; as a factor in some forms of 
affections of the eye, 199 ; value of morphia, 
hypodermically, in convulsions from, 218. 

Refrigeration as a means of disinfection, 462. 

Regions, elevated, in phthisis, 540. 

Relation : of diphtheria to potato blight, 150 f 
of the diseases of the lower animals to those of 
man, 235 ; of occupation to insanity, 253 ; 
between the age of the mother and the sex of 
the child, 304 : of sewer gas to typhoid fever^ 
384 ; legal, of color blindness, 504. 

Relatives, intermarriage of, a factor in heredity^. 
156. 

Relief; of pain from the application of sulphate 
of copper, 195 : of cough in phthisis, 304 ; of 
long standing necrosis by amputation of the 
thigh, 317. 

Religious objections to anesthetics, 304. 

Remarkable : and gratifying change, 127 ; ages,- 
263 : phenomenon in reproduction, 286. 

Remarks ; on the causes of concealed post-par- 
tum hemorrhage, 28 ; on a case of puerperal 
convulsions. 42 : on scurvy in civil life, 75 f 
on the rubber ball pessary, 108 : on the ex-- 
citing cause of sympathetic ophthalmia, 225 ; 
on the uses and abuses of the obstetric forceps^, 



XVI 



Index. 



261 ; on comparative epidemiology, 432 ; on 
the importance and treatment of anal fissure, 

■ 485. _ 

Remedies ; in headache, 101 ; for hiccup, 238, 
417 ; their action on the liver, 342, 

Remedy ; for color blindness, 325 ; new, in dys- 
entery, 347 ; for physical evil, 456 ; for rheu- 
matism, 501. 

Bemote results of post-partum hemorrhage, 388. 

Bemoval ; of a bug from the ear, three years 
after its introduction, 163 ; of epithelioma of 
conjunctiva without injury to the sight, 188 ; 
of foreign bodies from the ear and nose, 195, 
387 : of an adeno- sarcoma of the ovary by 
laparotomy, 424. 

Removing hairs, method of, 552. 

Report ; of the board of experts on the yellow 
fever epidemic, 130 ; of cases of stricture and 
gleet treated with galvanism, 360, 442 ; of a 
fatal case of ovariotomy, 530. 

Reporting clinical lectures, 479. 

Reproduction, remarkable phenomenon in, 286. 

Resection ; of several joints in the same in- 
dividual, 10 ; of the knee, 105. 

Resolutions of the Philadelphia board of health, 
373. 

Resorts for health ; in Egypt, 106 ; notes on, 131. 

Respiratory disease, an undescribed form of, 
537. 

Rest in disease, 544. 

Restorative for the hair, 326. 

Results ; of the contagious diseases acts, 150 ; 
of an amputation of the leg, 319 ; of syphi- 
litic infection, 381 , remote, of post-partum 
hemorrhage, 388. 

Retained placenta, 129. 

Retention of urine ; from cystitis, treated by in- 
jecting tannic and salicylic acids into the blad- 
der, 283 : in children, 410. 

Retinitis albuminurica, 342. 

Retroflected uterus, a new method of reducing, 
414. 

Retroversion of the uterus, 444. 

Reunion of divided tendons in open wounds, 
223. 

Reviews and Book Notices — 

Notes on current medical literature, 13, 35, 59, 
81, 102, 125, 146, 167, 213, 279, 300, 322, 
345, 367, 389, 431, 455, 476, 521, 541. 
Allingham — Diseases of the Rectum, 521. 
Appleton & Co. — Health Primers, 214. 
Ashhurst, John, Jr. — The Principles and Prac- 
tice of Surgery, 37. 
Atkinson— The Obstetric Procedure, 367. 
Attfield — Chemistry, 345. 
Atthill — Diseases Peculiar to Women, 256. 
Aveling — Influence of Posture on Women in 

Gynecic and Obstetric Practice, 168. 
Bartholow — Spermatorrhoea, 390. 
Beers — A Century of American Literature, 

147. 
Bennett — Treatment of Pulmonary Consump- 
tion by Hygiene, Climate and Medicine, 
168. 
JBrinton — Half-yearly Compendium of Medical 

Science, 103. 
Bryant — Practice of Surgery, 257. 
Chapin — Index to Medical Journals. 191. 
€lapp — Tabular Handbook of Auscultation and 
Percussion, 147. 



Cohen — Diseases of the Throat and Nasal Pas- 
sages, 521. 

Curling — Diseases of the Testis, 146. 

Delafield & Stillnian — A Manual of Physical 
Diagnosis, 37. 

Dohell — Loss of Weight, Blood Spitting and 
Lung Disease, 147. 

Ellis — Diseases of Children, 147: Demonstra- 
tions "of Anatomy, 410. 

Emmet — Principles and Practice of Gynecol- 
ogy, 301. _ _ 

Evans — Assimilation and Digestion. 214. 

Farquharson—A Guide to Therapeutics and 
Materia Medica, 476. 

Fox — Epitome of Skin Diseases, 279. 

Frerichs — Diseases of the Liver, 323, 390. 

Gant — The Science and Practice of Surgery, 
80. 

Godlee — An Atlas of Human Anatomy, 125. 

Ch^een — An Introduction to Morbid Anatomy, 
103. 

Habershon — Diseases of the Abdomen, 410. 

Hacldey — General Surgical Pathology and 
Therapeutics, 257. 

Hall — Differential Diagnosis, 36. 

Hammond — Fasting Girls, 345. 

Holbrook — Hygiene of the Brain : Aids to 
Family Government, 279. 

Hood — Gout, Rheumatism, etc., 323. 

Kellogg — Diphtheria, 191. 

Xidd — The Laws of Therapeutics, 476. 

Landolt — A Manual of Examination of the 
Eyes, 323. 

Loewenherg — Les Tumeur Adenoides du Pha- 
rynx Nasal, leur Influence sur 1' Audition, la 
Respiration et la Phonation, leur Traite- 
ment, 15. 

Mackenzie — Diphtheria, 191. 

Marsh — Section Cutting, 168. 

McSherry — Health, and How to Promote it, 
214. 

Morris — Anatomy of the Joints of Man, 367. 

Napheys — Modern Medical Therapeutics, 59. 

Neuhauer — Qualitative and Quantitative Ana- 
lysis of Urine, 390. 

Rice — Posological Table, 542. 

Rogers — The Great Physical Forces, 191. 

Shaffer — Potts' Disease, 542. 

Sayre — Organic Materia Medica and Phar- 
macal Botany, 14. 

Seller — Diagnosis and Treatment of the Throat 
and Nasal Cavities, 499. 

Smith — Diseases of Infancy and Childhood, 
301. 

StilUand Maisch — The National Dispensatory, 
300. 

Summers — Yellow Fever, 256. 

Tellor — Diseases of Live Stock, 255. 

Toland — Practical Surgery, 301. 

Transactions] of Medical Societies of Ohio, 
West Virginia, Oregon and Pennsylvania, 
15 ; of Minnesota, 37 ; of the American 
Ophthalmological Society, 168 : of the Wis- 
consin State Medical Society, 214 : of the 
American Medical Association, 279 ; of the 
Rhode Island Medical Society, 542. 

Vaughan — Chemical Physiology and Pathol- 
ogy, 147. 

Von Ziemssen — Cyclopedia of the Practice of 



Index^ 



xvii 



Wheeler — Medical Chemistry, 125. 

JTTizWaTcer— Physiology, 103. 

Wilson — Nava] Hygiene, 190. 

Worcester — Dictionary of the English Lan- 
guage, 257. 

Wyeth — Surgical Anatomy and Surgery, 499. 

Zeiller — Contributions to the History of the 
Development of Man, Mammals and Birds, 
36. 
Revival of venesection, 13. 
Rheumatic arthritis, poultices in, 165. 
Rheumatism ; effects of climate in 392 ; remedy 

for, 501. 
Rivers, filtration of, 553. 

Rubber ; ball pessary, 108 ; plasters, 329 ; band- 
age, solid, 369. 
Rules for the prevention of self abuse, 345. 
Rupture of the eyeball, 153. 
Russia, medical men in, 411. 
Russian ; army medical staff, 131 ; plague, 219. 

Safety of puncturing in hepatic abscess, 17. 

Salicin and its derivatives, 475. 

Salicylate of soda in chorea, .347. 

Salicylic acid ; eruption, 18 ; prolonged daily 
use of, 84 ; enemata, in dysentery, 238 ; in- 
jected into the bladder for cystitis with reten- 
tion of urine, 283. 

Salivary; secretions, their physiology, 111, 309; 
precautions neglected, in southern cities, 411. 

Sanitary protection associations, 110. 

Sanitation on shipboard, 17. 

Sarcoma of the uterus, 446. 

Scarlatina ; its treatment and prophylaxis, 205 ; 
identity of the poisons of diphtheria and, 392 ; 
diagnosis between erythema and, 452. 

Scarlet fever, the chlorine mixture in, 172. 

Schools, prevention of contagious diseases in. 552. 

Science, discouraging, 194. 

Sclerosis ; disseminated, 141, 182 ; multiple 
cerebro-spinal, 357 ; of the stomach, 460. 

Scrofula, a case of, 43. 

Scrofulosis, tayuya in, 18. 

Scurvy ; diagnosis and treatment of, 75 ; land, 
351. 

Sea; sickness, 414; weeds as medicinal agents, 
501. 

Seamen, examination of, 554. 

Season, and the mortality of either sex, 353. 

Secondary syphilis, 94. 

Second dorsal vertebra involved in gunshot in- 
jury, 228. 

Secret of metallo-therapy, 195. 

Secretion of milk, deficient, treatment of, 525. 

Secretions, salivary, their physiology. 111, 309. 

Section, anthropological, of Paris exhibition, 20. 

Self abuse, rules for the prevention of, 345. 

Selling diplomas, 175. 

Sense of smell. 302. 

Septic poisons compared with zymotic, 34. 

Septicaemia ; theory of death from, 170 ; causa- 
tion of, 276. 

Several joints resected in the same person, 10. 

Sex ; and the causes of mortality, 221 ; of the 
child, relation between the age of the mother 
and the, 304; mortality, of either, 353. 

Sexual connection, exhaustion from, 409. 

Sewer gas ; its relation to typhoid fever, 384 ; 
alleged blindness from, 549. 

Shipboard, sanitation on, 17. 



Shock, surgical, general symptoms and treat- 
ment of, 319. 

Shoulder presentation, 327. 

Siderodromophobia, 544. 

Sight, removal of epithelioma of conjunctiva,, 
without injury to the, 188. 

Sign of approaching death, 413. 

Significance ; of persistent vomiting in young- 
women, 184 ; of forms of the head, 194 ; of 
tremor, 299. 

Signs, pleuritic, simulated by worms, 326. 

Similarities, personal, 260. 

Simulated labor, 153. 

Simulation ; of pleuritic signs by worms, 326 ; of 
typhoid fever by cirrhotic kidney, 362. 

Singular wounds of the heart, 540. 

Sinus, congenital, from the pharynx to the sur- 
face of the neck, 247. 

Sixth decennial pharmacopoeia convention, 394, 

Size of the brain, 478. 

Skin ; in tinea tonsurans, 79 ; diseases, external 
treatment of, 529. 

Skull ; percussion of the, as a mode of diagnosis^ 
213 ; how to measure a, 454. 

Sleeplessness, suggestion for, 151. 

Small ; doses, 350 ; elastic bands as surgical ap- 
pliances, 460. 

Smallpox ; in Brazil, 131 ; and great pox, 429. 

Smell, the sense of, 302. 

Smith's method of treating false joint, 460. 

Smoking opium, effects of, 260. 

Soda ; treatment of burns, 170 ; salicylate of, in 
chorea, 347. 

Sodium, ethylate of, 80. 

Softness, morbid, of the uterus, 321. 

Solfatara treatment of phthisis, 2. 

Solid india-rubber bandage, 369. 

Solubility of chloral in fatty bodies, 40. 

Some ; therapeutic uses of alcohol, 12 ; forms of 
affections of the eye from reflex irritation, 199 ; 
of the clinical concomitants of idiopathic ery- 
sipelas, 287; cases of diphtheria, 393. 

Sound doctrine in therapeutics, 282. 

Source of the diphtheritic poison, 192.- 

Southern cities, neglect of sanitary precautions 
in, 411. 

Southwest, the practice of medicine and surgery 
by the aboriginal races of the, 157. 

Spasmodic dysmenorrhoea treated mechanically, 
477. 

Species of tapeworm now prevalent, 62. 

Spermatozoa, examination ofthe urine for, 501. 

Sphincter vesicae forcibly dilated, 471. 

Spinal; meningitis followed by disseminated 
sclerosis, 141, 182 ; sprain treated by the ac- 
tual cautery, 274. 

Spirits of nitre, poisoning from, 102. 

Splint, pasteboard, in treating fracture of the 
lower jaw, 317. 

Spontaneous; opening from empyema, followed 
by an immense abscess and a permanent fis- 
tula, with pneumothorax, 249 ; development 
of typhus, 255; cephalgematomata, 326. 

Sprains ; treatment of, 40, 53 ; of the spine 
treated by the actual cautery, 274. 

Spread of contagion, 58. 

Sputum in p)ulmonary gangrene, 545. 

Stables, the air of, 18. 

Staff; German medical, 21; of the Russian 
army, 131. 



XVIU 



Index, 



^tage ; of decline, in psoriasis, 122 ; third, in 
placenta prsevia labors, peculiarities of the, 
343. 

.'Stammering, 212. 

Startling case, 548. 

Starvation, chronic, its effect on the mind, 68. 

State ; medicine in Pennsylvania, 66 ; of the 
heart as an element of prognosis in typhoid 
fever, 189 ; board of health in North Carolina, 
873. 

Statistics ; vital, of New York city in 1878, 43 
of Providence, P. I., 44; of London, 110 
homoeopathic, 329 ; of insane hospitals, 457 
of burial alive, 483. 

Steamer "Plymouth," U. S., yellow fever on 
the, 351. 

,Stenosis of the fauces, operation for, 381. 

Sterility, dilatation of the os for, 344. 

Stomach; foreign body in the, 153; irritable, 
tincture of walnuts in, 259 ; treatment of 
catarrh of the, 364 ; sclerosis of the, 460. 

•Stone in the bladder, early symptoms of 234. 

Strain, mental, physical disease resulting from, 
271. 

Stramonium poisoning, 548. 

Strangulated hernia treated by ergotine, 888. 

Stretching ; the facial nerve for convulsive tic, 
83 ; of the nerve, in anaesthetic leprosy, 255 ; 
in tetanus, 297. 

Stricture ; with perineal fistulse, 249 ; treated 
with galvanism, 360, 442 ; at the pyloric ori- 
fice, 460 ; urethral, 468. 

Strychnia, monobromide of camphor as an anti- 
dote to, 18. 

Studies ; on diabetes mellitus, 11 ; of ineliriety, 
72 ; on the physiology of conception, 349, 

Study of disease ; in the light of Darwinian doc- 
trines, 143 ; advantages of the country practi- 
tioner in the, 466. 

Stump, mode of dressing and cleansing the, in 
amputation, 319. 

Subacute melancholia, with suicidal propensity, 
403. 

Subcutaneous ligation, for varicocele, 382. 

Subinvolution of the perineum, 428. 

Substances ; albuminous, in the urine, 33 ; action 
of, on the teeth, 238. 

Success ; of jaborandi in dropsy, and ergot and 
iron in albuminuria, 210 ; of iodide of potas- 
sium and aconite in thoracic aneurism, 275. 

Successful case of ovariotomy, 441. 

Sufferings in Brazil, 197. 

Suggestion ; for swollen fingers, 11 ; for sleep- 
lessness, 151 ; for the removal of foreign 
bodies from the ears and nose, 387 ; on ozsena, 
408. 

Suicide ; and insanity, 62 ; the law of average in, 
237. 

Suits for malpractice, 197. 

Sulphate of copper, relief of pain from the appli- 
cation of, 195. 

Sulphides, administration of the, 638. 

Sunstroke ; inebriety from, 72 ; weather, 413. 

Suppositories of ergotine in uterine fibroids, 365. 

Suppression of urine, external use of digitalis for, 
166. 

Surgery ; antiseptic, its success, 84«; as prac- 
ticed by the aboriginal races of the southwest, 
157. 

;Surgical ; treatment; of lupus, 33; of anasarca. 



144, 300 ; of chronic metritis, 254 ; shock, gen- 
eral symptoms and treatment of, 319 ; appli- 
ances, small elastic bands as, 460. 

Suture of nerves, 343. 

Sweats, night, jaborandi in, 434. 

Sweet spirits of nitre, poisoning from, 102. 

Swollen fingers, treatment of, 11. 

Symmetrical angesthesia, 128. 

Sympathetic ophthalmia, 225 , irritation of the, 
through the pharynx, 430. 

Symptoms ; early, of stone in the bladder, 234 ; 
of yellow fever, 269 ; of compression of the 
brain from clot, 273 ; of croup, 275 ; of surgi- 
cal shock, 319. 

Syphilide, general papular, 123. 

Syphilis; secondary, 94 ; latent, 189 ; d'emblee, 
348 ; locomotor ataxy simulated by, 452 ; pilo- 
carpinin, 537. 

Syphilitic ; brain disease, 77 ; onychia, 122 ; 
bursitis, 123 ; milkmen, 151 ; consumption, 
370 ; infection, two results of, 381. 

System ; the metrical, in Great Britain, 21 ; in 
this country, 219, 391. 

Table diet for diabetics, 238. 

Tannic acid injected into the bladder, in cystitis, 
with retention of urine, 283. 

Tapeworm ; the species now prevalent, 62 ,• 
recipe for, 417. 

Tapping the lungs in phthisis, 10. 

Tartrate of morphia for hypodermic injection, 
365. 

Tasteless purgative, 349. 

Taxis, incarcerated femoral hernia partially re- 
duced by, 383. 

Tayuya in scrofulosis, 18. 

Teale's method of forced dilatation, 471. 

Teeth, action of substances on the, 238. 

Tendons, divided, reunion of, in open wounds. 
223. 

Terrible burn, its treatment, 335. 

Testimony, medical, 7. 

Tetanus ; traumatic, 177, 402 ; nerve stretching 
in, 297 ; pathology of, 412. 

Theories of epidemiology, 126. 

Theory ; of death in septicaemia and charbon, 
170 ; and therapeusis for chorea, 414. 

Therapeutic; uses of alcohol, 12; of belladonna, 
320 ; value of oxygen, 145 ; of croton- chloral, 
498. 

Therapeutics ; the laws of, 106 ; sound doctrine 
in, 282 ; of metals in a case of hysterical hy- 
"perEesthesia, 265 ; the progress of, 458. 

Therapeutical agent, aconite a, 407. 

Thigh, amputation of the, for long standing ne- 
crosis, 317. 

Third stage in placenta preevia labors, peculiari- 
ties of the, 843. 

Thoracentesis in phthisis, 57. 

Thoracic aneurism treated by iodide of potas- 
sium and aconite, 275. 

Thoughts on midwifery, 8, 49, 133, 267, 291. 

Threatenings of yellow fever, 829. 

Thrombus, the organization of, 167. 

Thymol and its uses, 17. 

Tibia, ununited fracture of the, 471. 

Tic, convulsive, stretching the facial nerve for, 88. 

Tincture ; veratrum viride, alleged poisonous 
dose of, 288 ; Warburg's, in malarial diseases, 
255 ; of walnuts, in irritable stomach, 259. 



Index, 



XIX 



Tinea ; tonsurans, the skin in, 79 ; tricophytina 
capitis, 186. 

Tobacco ; the use of, 20 ; amblyopia from, 193 ; 
the effects of, 276. 

Toe nail, inverted, 527. 

Tongue, destruction of the, 381. 

Tonsillitis, 9. 

Tracheotomy in membranous croup, 277. 

Trade marks as applied to therapeuticals, -215. 
t Transfusion ; experiments in, 79, 230. 

Transmission, hereditary, of heart disease, 127. 

Traumatic ; perforation of the membrana tym- 
pani, 161 ; tetanus treated by chloral, 177, 
402 ; meningitis, cold douche treatment of, 
636. 

Treatment ; solfatara, of phthisis, 2 ; of swollen 
fingers, 11; of uterine inflammation, 11; of 
croup and diphtheria, 12, 19, 165, 321, 400, 
430; of lupus, 33, 107; of sprains, iO ; of 
scurvy, 75 ; of acne, 79 ; of lunacy, 83 ; of ul- 
cers, 128 ; of ngevus with croton oil, 123 ; of 
epilepsy, 129, 144 ; rational, of typhoid fever, 
139; of disseminated spinal sclerosis, 141, 
182; surgical, of anasarca, 144, 300; of true 
croup and acute laryngitis, by ice, 151 ; of 
burns by soda, 170 ; of traumatic tetanus by 
chloral, 177 ; rational, of persistent vomiting, 
in young women, 184; of trigeminal neuralgia, 
188 ; of scarlatina, 205 ; of influenza, 208 ; of 
acute and chronic tubal nephritis, 210 ; of 
warts by chromic acid, 217 ; of chorea, 253 ; 
surgical, of chronic metritis, 255; abortive, of 
bubo, 260; of yellow fever, 269; of compres- 
sion of the brain, from clot, 273 ; of paraple- 
gia from a spinal sprain, by the actual cautery, 
274 ; of epithelial cancer by chromic acid, 
275 ; of thoracic aneurism by iodide of potas- 
sium and aconite, 275 ; antiseptic, of empy- 
ema in children, 278 ; of cystitis, by injections 
of tannic and salicylic acids into the bladder, 
283 ; of obstinate psoriasis, 298 ; of acute ob- 
struction of the bowels, 298 ; of alcoholism, 
299 ; of fracture of the lower jaw with a paste- 
board splint, 317 ; of surgical shock, 319 ; of 
the albuminuria of pregnancy by jaborandi, 
326 ; of burn, 335 ; of chronic tubal nephritis, 
with uraemia, 341 ; of stricture and gleet with 
galvanism, 360 ; of uraemia, 361 ; of catarrh 
of the stomach, 364 ; of whooping cough, 366 ; 
of enlarged glands, 371 ; of varicocele by sub- 
cutaneous ligation, 382 ; in operation for equi- 
no-varus without mechanical appliances,- 384 ; 
of infantile paralysis, 387 ; of strangHIated 
hernia by ergotine, 388 ; of exhaustion from 
sexual connection, 409 ; of goitre, 409 ; of 
measles with cool air and water, 414 ; of 
rabies by oxygen, 433 ; of diarrhoea by the hot 
water douche, 433 ; of stricture and gleet with 
galvanism, 442 ; of internal aneurism, 451 ; of 
albuminuria by oxygen, 454 ; of piles by car- 
bolic injections, 458; of false joint by Prof. 
Henry H. Smith's method, 460 ; mechanical, 
of spasmodic dysmenorrhoea, 474 ; of anal fis- 
sure, 485 ; of chronic ovaritis, 497 ; of puer- 
pe'ral mania, 498 ; of typhoid fever, 498 ; of 
hepatic abscess, 519 ; for deficient secretion of 
milk, 525 ; of irritable ulcer of the rectum, 
526 ; external, of skin diseases, 529 ; of trau- 
matic meningitis, 536 ; of mydriasis, 538. 

Trephining, 43. 



Trichina in American pork, 107. 

Trigeminal neuralgia, treatment of, 188. 

Tremor, significance of, 299. 

Truth about the climate of Nice, 544. 

Tubal nephritis, its treatment, 210, 339, 340, 
341. 

Tuberculosis, the contagion of, 82. 

Tumor ; venous, 247 ; abdominal, 405 ; fibro- 
cystic, of the uterus, ;^427 ; mammary, rare 
form of, 459. 

Turntable, the foundlings', 197. 

Twin monster, 21. 

Type of pulmonary disease, 394. 

Typhoid fever ; from defective drainage, 97 ; 
elements of prognosis in, rational treatment of, 
139 ; simulated by acute exacerbation of cir- 
rhotic kidney, with peritonitis and pleurisy, 
362 ; relation of sewer gas to, 384 ; the fungus 
of, 387 ; identity of the poisons of scarlatina 
and, 392; cold water in, 408; treatment of, 
495. 

Typhus, spontaneous development of, 255, 

Ulcer of the rectum treated by forcible dilatation, 
526. _ ■ 

Ulcerations of the cervix uteri, 524. 

Uterus, treatment of, 128. 

Umbilical hernia, 246. 

Undescribed form of respiratory disease, 537. 

United States Marine Hospital service, changes 
in 461. 

University of Pennsylvania commencement, 262. 

Ununited fracture of the tibia, 471. 

Uraemia ; chronic tubal nephritis, with, 341 ; 
treatment of; death from, 361. 

Urethra; laceration of the, 463 ; stricture of the, 
468. 

Urethral calculus, impacted, 539. 

Urine ; albuminous substances in the, 33 ; exter- 
nal use of digitalis in suppression of, 166 ; in- 
continence of, in children, 190, 410 ; retention 
of, treated by injections of tannic and salicylic 
acids into the bladder, 283 ; examination of, 
for spermatozoa, 501. 

Urticaria ; infantile, 122 ; atropia in, 370. 

Use ; of tobacco^ 20, 193 ; of chloroform in 
labor, 32 ; in diseases of the heart, 277 ; of 
the actual cautery, 39 ; hypodermic, of mer- 
cury, 63 ; of quinine, 277 ; of salicylic acid, 
84; of dextro- quinine, 85; of the forceps 
when the os uteri is partially dilated, 124 ; of 
calcined magnesia as a laxative, its dangers, 
129 ; of digitalis in suppression of urine, 166 ; 
of the forceps in labor, 213 ; of white wines, 
303 ; of anaesthetics, prevention of fatal acci- 
dent from the, 388 ; of koumiss, 406 ; of cin- 
, chona, 520. 

Uses ; therapeutic, of alcohol, 12 ; of thymol, 
17 ; of the obstetric forceps, 261 ; of bella- 
donna, 320 ; of nitro-glycerine, 389 ; of pal- 
metto berries, 525. 

Uterine; inflammation, positional treatment of 
11 ; disease, its influence on nervous disor- 
ders, 63 ; displacements, instrumental inter- 
ference in, 180 ; hemorrhage, warm fomenta- 
tions to the head in, 278 ; fibroids, ergotine 
suppositories in, 365. 

Uterus ; antecurvature of the, 124 ; morbid soft- 
ness of the, 821 ; retroflected. a new method of 
reducing a, 414 ; probable nbro-cystic tumor 



XX 



Index^ 



of the, complicated with pregnancy, 427 ; sar- 
coma of the, 446. 

Vaccino-syphilis, diagnosis of, 407. 

Value ; of chlorine in diphtheria, 84 ; of a " mad 
stone," 109; therapeutic, of oxygen, 145; of 
morphia, hypodermically, in convulsions from 
reflex irritation, 218 ; of venesection, 254 ; of 
nutritive enemata, 413 ; of Teale's method of 
forced dilatation, 471 ; of croton-chloral, 498 ; 
of sea weeds as medicinal agents, 501. 

Varicocele treated by subcutaneous ligation, 382. 

Varieties of cremation, 280. 

Vegetable pepsin, 413. 

Venereal warts, 282, 328. 

Venesection ; revival of, 13 ; vajue of, 225 ; in 
apoplexy, 259. 

Venous tumor or mole, 247. 

Veratrum viride, an alleged poisonous dose of, 
288, 305, 349, 372, 417, 457. 

Verminal leucorrhoea of infants, 172. 

Vertebra, second dorsal, involved in a gunshot 
injury, 228. 

Vesico-vaginal fistula, 447. 

Vieirin, or vieiric acid, 277. 

Virus, equine, for vaccination, 413. 

Vital statistics; of New York city in 1878, 43 ; 
of London, 110. 

Vomiting ; after operations, 34 ; persistent, in 
young women, its rational treatment, 184 ; of 
pregnancy, 525. 

Vulvo-vaginal gland, cyst of the, 426. 

Wahoo berk, fluid extracts of, 418. 

Walk of Mad-fime Anderson, 87. 

Walnuts, tincture of, in irritable stomach, 259. 

Warburg's tincture in malarial diseases, 255. 

Warm fomentations to the head, in cases of 

uterine hemorrhage, 278. 
Warts, chromic acid for, 217 ; venereal, 282, 328. 



Wasting diseases, mead in, 370. 

Water ; chlorine, in diphtheria, 196 ; Apollin- 

aris, 373 ; c ' ' " 

measles, 414. 
Waterproof paper, 331. 
Weather, sunstroke, 413. 
Weeds, sea, as medicinal agents, 501. 
Westphal's diagnostic point in locomotor ataxia, 

18. _ 

What constitutes hermaphroditism, 524. 
White wines, the use of, 303. 
Whooping cough, treatment of, 366, 475. 
Wide distribution of the influenza epidemic^ 

208. 
Wire loop, gynecological, 130. 
Wisconsin medical act, 307. 
Women ; young, rational treatment of persistent 

vomiting in, 184 ; general paralysis in, 253 j 

pregiiant, ovarian pain in, 540. 
Worms, simulation of pleuritic signs, by, 326. 
Worth of the metric system, 391. 
Wound, gunshot, of heart, 188. 
Wounds ; perforating, of the membrana tympani,, 

161 ; open, the reunion of divided tendons 

in, 223 ; balsam of Peru in, 370 ; of the heart. 

540. 

Yellow fever; the contagion of, 41, 240, 305, 
454 ; the cause of, 64 ; investigation of, 66, 
130; introduction of, 85; still alive ; 175, 395 ; 
symptoms, pathology and treatment of, 269 ; 
. threatenings, 329; on the U. S. steamer "Ply- 
mouth," 351; at Port-au-Prince, 504. 

Young women, rational treatment of persistent 
vomiting in, 184. 

Zinc, oleate of, 64, 478. 

Zymotic and septic poisons comparef', 34. 



I 



1 



^ 



WHOLE No. 3140.] 



JANUARY 4, 1879. 



[VOL. XL, No. 1. 




a?H: E 



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r()MMCMt;.A.'ri()>JS. 
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THE 



MEDICAL AND SURGICAL REPORTER 



No. 1140.1 



PHILADELPHIA, JAN. 4, 1879. 



[Vol. XL.— No. 1. 



Original Department, 



Lfcture 

on diseases of childeen. 

Delivered afc the College of Physicians and Sur- 
geons, New York. 

BY PROF, A. JACOBI. 

Reported expressly for the MBDtCAL and Surgical. 
Reporter. 

Eachitis, with Crepitation in the Knee Joint. 

Gentlemen: — Here is an infant, nine months 
old, which the mother has brought us, not because 
she thinks it is ill, but because she has lately dis- 
covered that *' its knees crack ; " and this has wor- 
ried her. It is about a week since she noticed it 
for the first time. On making an examination for 
ourselves, the mother's account is confirmed; for, 
when we hold the femur firmly, and rock the leg 
from side to side, we get a sort of crepitus in the 
knee. It needs but a glance at the general ap- 
pearance of the child, however, to determine the 
explanation of this phenomenon. The shape and 
other characteristics of the head, the peculiar 
formation of the chest, due to the abnormally soft 
condition of the ribs, the large abdomen, all show 
that the infant is markedly rachitical. Therefore 
the soft state of both the ligaments and bones inci'- 
dental to the rachitis admits of a wider play than 
usual about the joint, and consequently, the motion 
of the hard surfaces upon each other produce the 
crepitation noticed^ It is due to nothing else, I 
assure you, than rachitical elongation of the syno- 
vial membrane of the joint. 

When we come to inquire into the feeding of 
the child, we find that although the mother is still 
nursing it at the breast, she has been in, th^ habit 
of giving it farina, potatoes, bread and butter, and 
other articles " whenever the baby wanted them ; " 
1 



which, of course, means very often indeed. Now, 
even if the food employed was altogether of the 
most appropriate character, it would be impossible 
for any infant to digest it if given in this very 
frequent and irregular manner, and it is a well 
ascertained fact that rachitis, when not due to any 
hereditary tendency or to pulmonary trouble, is 
always the result of improper feeding. 

The first thing to be done by way of treatment 
here, then, is to regulate the diet of the child, and see 
that it has five or six, instead of a dozen or fifteen 
meals a day. As it has contracted racliitis while 
taking the mother's milk, I think it had better be 
weaned now and given something else. At first I 
will order it one part of cow's milk to three parts 
of barley water, with the addition of a little salt 
and sugar. As its bowels are not constipated I 
mention barley water; but if they were, I would 
suggest oatmeal instead. By way of medication I 
think a little syrup of the iodide of iron will be all 
that the child requires at present ; and this will 
act as a tonic and an alterant, as well as tend to 
prevent the fermentation which so commonly goes 
on in the alimentary tract of rachitical children. 

Malnutrition and Diarrhoea in an Infant, from 
Improper Feeding. 

The following history is given of this infant : 
Mary F., six weeks old, was healthy when born. 
When two weeks old the mother says that it had 
white spots in the mouth, which gradually in- 
creased in number. There were also spots on its 
legs, which looked like prickly heat. After that 
its bowels became loose, the evacuations being 
green in color and containing white lumps ; and it 
began to lose flesh. Its buttocks, and genitals, and 
groins soon became sore and inflamed, and when 
it was a month old it commenced to vomit. It has 
also had a slight cough. The father and mother 



Lecture. 



[Vol. xl, 



are healthy. They have had nine children, six of 
whom are still living. Of the three that died one 
was born very feeble and did not live long ; the 
second died of whooping-cough, and the third 
while teething, at the age of ten months. The 
mother has had but one miscarriage : and so we 
can, at all events, probably exclude syphilis as 
having anything to do with this infant's trouble. 
Neither does there seem to be any other hereditary 
t'iint, and, therefore, we must look for some cause 
or causes of the difficulty in the child itself. 

The spots in the mouth, of which the mother 
spoke, were, no doubt, thrush, or muguet, as the 
French call it, and they have all now disappeared ; 
though the pharynx still presents a redder appear- 
ance than normal. On examination we find a 
Tv'ell-marked erythema about the labia majora and 
arms, and also upon the inner surface of the thighs- 
An eruption of this character is usually due to ex- 
ternal irritation, such as is liable to be set up by 
contact of faeces or urine with the skin, when per- 
fect cleanliness is not observed. One of the most 
common of all the causes of infantile erythema is 
the use of diapers which have been wet with urine 
and then simply allowed to dry, without having 
first been washed. In the present instance the 
trouble is probably attributable to the diarrhoea from 
which the child has been suffering. As to the 
diarrhoea itself, the cause of that we shall no doubt 
find to have been improper feeding; the food 
being either of an inappropriate kind, or else ad- 
ministered in too large quantities, or too fre- 
quently. The infant has also had another erup- 
tion, which has been described as prickly heat, 
and although prickly heat is not very often met 
with at this season of the year, 1 think the mother 
was probably right in so denominating it. It is 
easy enough to maintain summer heat in a bed- 
room, and the little vesicles seen in the eruption 
mentioned sometimes make their appearance on 
children who are kept too warm, and not allowed 
sufficient fresh air. 

For the erythema I would suggest oxide of zinc, 
or diachylon, ointment ; or it may be that simply 
a powder will suffice. Lycopodium, however, 
should never be used in such cases, as it unites 
will the effused serum, to form a mass which is 
very irritating to the inflamed skin. The best 
powd. r here would probably be one composed of 
starch and oxide of zinc. To protect the parts 
mcst exposed to it from the irritation of the faeces 
and urine a little cold cream, or simple cerate 
should be employed now and then. At the same 
time they should be kept as cool as possible. 

As the diarrhoea, in all probability, depends upon 
improper feeding, it follows, of course, that in 



order to get rid of it we must address ourselves 
to the cause. The mother being unable to nurse 
the child at the breast, I would suggest that it 
should have cow's milk, which has been boiled 
and skimmed, diluted from one-half to one-third. 
Instead of adding simple water to the milk, how- 
ever, we should employ a farinaceous gruel ; and 
here barley water would be the most appropriate. 
Oatmeal, which would only tend to increase the 
diarrhoea in this case, is very useful where the 
bowels are constipated. If there is acidity, a little 
lime water may be used. It is a great mistake, how- 
ever, to suppose that lime water is really worth 
anything as an antacid, because, so feeble is its 
aiction in this respect, that a vast quantity of it 
would in fact be necessary in order to produce any 
appreciable effect in neutralizing acidity by means 
of it. Still it is often very serviceable in such 
cases, and especially if there is but little acid 
present. It also has a very excellent effect in 
interfering to some extent with the coagulation of 
the milk ; for it is found that when lime water is 
given with it the coagula are not so large or so 
firm as they would have been had it not been 
employed. The white lumps in the child's pass- 
ages, which were described by the mother, are 
made up of casein and fat, and they indicate 
either that the stomach does not digest properly, 
or that the quantity of milk taken by the child is 
too large. If necessary, the milk may be reduced 
until it is only in the proportion of one to three ; 
and in case the diarrhoea should continue, it might 
perhaps be well to allow no milk at all for a period 
of twelve or twenty-lour hours. In some cases it 
is desirable to withdraw the milk for even three or 
four days ; in the meanwhile giving the child 
barley water and white of egg. 



The Solfatara Treatment of PhtMsis. 
Dr. H. E.. Storer has, within the last year or two, 
introduced to the American and English publics, 
in various articles, the alleged advantages to con- 
sumptives of a treatment by the natural sulphur 
craters of Pezzuoli, near Naples. On the other 
side, we notice a paper has been published in the 
Annali Clinici, of Naples, by Dr. Petterutti, de- 
tailing experiments with a number of phthisical 
cases, which seem to show that the solfatara treat- 
ment is of no sort of value, or at most, but as a 
slight and temporary alleviation. What advan- 
tages were derived, were due to the change of diet, 
outdoor life, etc. But as to a cure, or any condi- 
tion at all approaching it, there was no sign of 
one. We rather think that Dr. Storer's well 
known enthusiasm has led him to over-estimate 
largely the effects of the sulphurous atmosphere. 



Jan. 4, 1879.] 



Communications. 



Communications. 



THOUGHTS ON MIDWIFEEY— No. 1. 

BY HIRAM COESON, M.D., 
Of Conshohocken, Pa. 

Fifty years ago we were men-midwives, twenty 
years ago came to be obstetricians, now we are gyne- 
cologists. In the first period of time physicians 
regarded midwifery as a part of the practice of 
medicine ; now it is a department of surgery. Then, 
delivery by the forceps was rarely resorted to, but 
the condition of the woman was carefully watched 
and attended to, while the physician and attend- 
ants were waiting the steady and generally efiicient 
efforts of the womb to deliver the child. Then, 
ruptm-es of the perineum and os uteri were very 
rare, and save in cases where ergot was used too 
early, or injudiciously, still-born children were 
seldom seen. Now, lacerations of the perineum 
are so frequent that operations for the restoration 
of the parts contribute to the income of our best 
surgeons. Then, physicians went to attend their 
cases without obstetrical instruments — armed only 
with the catheter, lancet, laudanum and ergot. 
Now, the young physician, with the fear of rigid 
OS uteri, resisting perineum and uterine hemor- 
rhage before his eyes, carries a scalpel to nick the 
rigid OS, and to cut, according to geometrical rules, 
not the perineum, but the sides of the vaginal 
opening, at an angle accurately described by ex- 
perienced teachers ; needles and wire, shot and 
tweezers, to close again the divided parts ; forceps, 
to bring away the child speedily when the labor 
has as yet but fairly begun ; ether, and brandy, 
and vinegar, to use as occasion may require ; an 
array which, certainly, if it serve no other purpose, 
will add to the importance of the doctor in the 
opinion of the patient and her friends. 

At the recent meeting of the American Gyneco- 
logical Society, in Philadelphia, the papers read 
and the discussions on them were deeply interest- 
ing, but they presented the dangers attending ordi- 
nary labor as being so numerous and so fearful, 
that a person unacquainted with the process 
would have reasonably supposed that but few 
women could pass through it unharmed. The 
frequent use of the forceps was urged by several 
of the celebrated men, who joined Dr. Fordyce 
Barker in the assertion that "the longer he 
practiced the more he was inclined to use the 
forceps," and that they were not the frequent 
cause of laceration of the perineum. We are 
greatly disposed to follow the lead of eminent 
men, and it was very noticeable on that occasion. 



The utterance of Doctor Barker was echoed by 
various speakers, until it really seemed as though 
it was a settled fact that the forceps could scarcely 
be dispensed with in any labor, if we wished to 
save the woman from hours of needless suffering, 
from vesico-vaginal fistula, from laceration of the 
perineum, from uterine hemorrhage and ruptured 
bladder. 

It was, then, a comfort to hear Dr. Humphrey 
Storer, a man of great experience, say, "that 
among the several thousand cases of midwifery 
which he had attended, there had occurred (only) 
two cases of vesico-vaginal fistula. In the city 
from which he came there was no man used the 
forceps more seldom than he did. Doubtless the 
instrument was of great service, but the idea that 
it was constantly to be used was one which should 
be carefully considered. There was no question 
but that certain accidents had attended the use of 
the force f)s, such as rupture of the perineum, etc., 
and he believed we should be exceedingly careful, 
and point out the fact that injury was produced by 
their too frequent application. His view was, that 
they were oftentimes improperly employed, under 
improper circumstances, and that therefore the 
Society should be cautious in the expression of 
views which were specially to influence the younger 
members of the profession." With reference to 
the occurrence of lacerated perineum as frequently 
when forceps were not used as when they were 
used, as had been stated by Dr. Wilson, of Balti- 
more, Dr. Storer said, " that in almost every case 
of that character which had fallen under his 
observation, the injury had been produced by the 
use of the forceps." It was a pleasant sight to see 
this gentle, intellectual-looking, aged man, who 
had witnessed the birth of many thousand chil- 
dren, standing up in the face of these many advo- 
cates of the forceps — the followers of fashion in 
practice — and declaring to them the unwelcome 
truth that the forceps had been the cause of nearly 
all the lacerations of the perineum which had 
come under Jiis observation. 

And when the discussion seemed to be closed it 
was cheering to hear the skillful Dr. Goodell, the 
president of the meeting, say, " that he was inclined 
to agree with Dr. Storer with reference to the fre- 
quent use of the forceps. That the skilled operator 
could use them without reference to special rules, 
but it was well-known that the perineum espe- 
cially, and not infrequently the cervix uteri, were' 
ruptured in consequence of the use of the forceps, 
by those who were inexperienced in that instru- 
mental operation, and therefore he feared that the 
teachings of the discussion, unless somewhat quali- 
fied, might do harm." 



Communications. 



[Vol. xl, 



These were words fitly spoken, but I fear they 
will have but little influence in guarding the many 
teachers of midwifery who were present against 
urging upon their pupils the advantage of taking 
the labor away from the agents which nature has 
provided, and effecting it by means of the forceps. 
How fearful are the results of such teaching ! The 
lacerations and the still-born, do not they bear wit- 
ness? 

A paper, " On the Surgical Treatment of Dys- 
menorrhoea," by Dr. Marion Sims, was, in his ab- 
sence, read by the Secretary. From this it appeared 
that the bilateral incision of the cervix uteri, so 
often performed by Dr. Simpson, was rejected by Dr. 
Sims, who advocated strongly the antero-posterior 
incision, which he had performed in nearly or 
quite a thousand cases in about twenty years. 

It was well done in Dr. Barker to inquire, " How 
did it happen that one man believed that in twenty 
years he had found nearly a thousand cases in 
which the cervix needed incision, while others, 
whose sphere of gynecological observation had been 
equally large, in both hospital and private practice, 
and who fully believed in the propriety and utility 
of the operation, had not found occasion to perform 
it in one-fifth of that number of instances ? " 

There was much discussion on the subject, but 
for my purpose it is sufl&cient to say that while 
several, indeed nearly all of them, favored the 
catting operation, "when necessary," there was a 
general concurrence in the belief that it was too 
frequently performed, and that there was danger in 
it ; that cellulitis and death were not uncommon. 

I was deeply impressed by this discussion. Here 
were many justly celebrated men speaking of the 
treatment of a disease, or more properly, a mere 
disability and destitute of danger, by making in- 
cisions through the neck and mouth of the womb, 
which are always hazardous and sometimes pro- 
duce death, while there were those sitting there as 
listeners who had attended thousands of women and 
had relieved like disabilities by remedies speedily 
efiicient and yet neither unpleasant nor dangerous. 
It was a confirmation to me of a belief long enter- 
tained, that there are serious objections to special- 
ists in midwifery. 

Once a month a woman has much pain for a 
few hours, followed by scanty menstrual discharge, 
and if married for a year or two without becoming 
pregnant, applies to her physician. If a man of 
experience in the practice of medicine, he pre- 
scribes, just prior to the monthly period, medicine 
to moderate or prevent pain, and very probably 
the next period will find her restored to health ; 
but, if not, a continuation of the remedies will in 
most cases work a complete cure. But what of the 



uncured cases? These, I am happy to say, he 
would relieve by gentle, careful dilatation — if a 
case of stenosis — which neither risks life nor causes 
death. Or, if an incorrigible case, he might follow 
the practice of forcible dilatation advocated in that 
meeting by Dr. Ellwood Wilson, as greatly to be 
preferred to incision. But suppose such a case to 
fall into the hands of a specialist in the art, one 
who has separated himself from "general prac- 
tice ; " what will he do ? He must do something 
beyond what a mere physician could be expected 
to do with his drugs. Disregarding the condition 
of his patient, making but little inquiry into the 
physical and moral causes, the e very-day-life, the 
domestic trouble, the various circumstances which 
combine to deteriorate health, he sees only a 
woman who suffers at her monthly periods, has 
pain, and scant menstrual discharge, and he jumps 
to the conclusion that there is a flexion, or version 
of the womb, or that the mouth or the neck of it is 
somehow at fault ; and having, as he believes, as- 
certained the need of an operation, and gratified 
by the opportunity to add another to his growing 
list of cases, he stops not to consider the risk to his 
patient, but plunges his knife bi-laterally, or 
antero-posteriorly — as he follows this or that 
master — through the neck of the womb, and slits it 
down through its mouth. 

To me such a procedure seems shameful. What 
was there in the condition of this patient that de- 
manded an operation declared by some of our 
most eminent men to be always dangerous and oft- 
times fatal ? Nothing that could not most proba- 
bly have been relieved by an intelligent physician. 
Her life was not endangered by her disability; 
her monthly sufferings not a whit greater than 
those borne by many women who enjoy good 
health and have borne several children. 

But do I hear some one say that the operation 
is performed in order to place the womb in a con- 
dition to facilitate impregnation ? Do statistics 
prove that such a result is likely to follow ? 

Dr. Noeggerath said, "that though cases -were 
cured of the stenosis for two or three months, yet 
after eight or ten months they were in , the same 
condition as before the operation ;" and Dr. Emmet 
closed the discussion by the remark that, " Me- 
chanical dysmenorrhcea, as a rule, is a myth, 
because it almost always depends on some defect 
in nutrition, apart from the uterus." 

Even those who favored the operation in some 
cases, admitted its dangers, and could not speak 
with much confidence of its value, and Dr. Barker 
boldly said, "that in the most skilled hands the 
operation was attended with some risks ; not only 
failure to improve the health and condition of the 



Jan 4, 1 879-] 



Communications, 



patient, but absolute danger to life. In New 
York city alone there had been sixteen deaths from 
this operation which had never been reported." 

If all these utterances are true, how shamefiil 
are these experiments on women. 

There were other subjects discussed which I 
may notice hereafter, in order that the readers of 
your journal may be informed touching the dis- 
cordant views of eminent obstetricians, and may, 
instead of thoughtlessly following the teaching of 
expert operators, take counsel of their own expe- 
rience. 

DIPHTHERIA AND ALCOHOL. 

BY C. H. LEWIS, M.D., 
Of Jackson, Michigan. 

For twenty years this country has been scourged 
with successive epidemics of diphtheria, and yet 
we are practically as ignorant both of its ^^fons et 
origo " and of effective prophylactic means to-day 
as when its first wave struck our eastern coast. 
And who that, with a humiliating sense of help- 
lessness, has been a witness of its ravages year 
after year, can feel satisfied with the progress made 
toward a successful treatment of this disease ? 'Tis 
true that many survive a severe attack, by virtue of 
the " vis medicatrix naturae," sometimes with the 
aid of treatment and sometimes in spite of it, but 
how many of these are "saved so as by fire," 
through an experience of anaemia, local paralyses, 
and ph^ical bankruptcy ! Earely do we expect a 
malignant case to recover, and we have come to 
look upon a death rate equal to that in the late 
visitation of yellow fever as something fore- 
ordained and inevitable in every severe epidemic 
of diphtheria. 

In view of the present prevalence of this disease 
in some sections, and the near approach of the 
season during which, in epidemic form, it is wont 
to number its victims by hundreds, is it not the 
part of wisdom for us who must stand in the 
breach and bear the brunt of the fight, to 
burnish our armor by a free interchange of 
ideas and experiences? If any have attained 
to a success above the average, the knowledge 
of means thus successfully employed should 
not be looked upon as personal property, but as a 
trust to be contributed to the common fund and 
used for the general good, while all should be 
eager to subject to the test of bedside experience 
such of these contributions as commend themselves 
to our judgment. 

Dr. E. N. Chapman, of Brooklyn, N. Y., in a 
monograph entitled " Antagonism of Alcohol and 
Diphtheria," enunciates the strong proposition 



that "Alcohol is as antagonistic to diphtheria as 
belladonna to opium, or quinia to malaria,"' 
claiming for it invincible prophylactic, antidotal, 
and remedial power. This proposition he deJucen 
from an actual clinical trial of fifteen years ; and 
he assures his readers that in a series of 125 suc- 
cessive ca'^es, embracing all grades of severity and 
every variety of complication, and extending 
through four epidemics in which the mortality 
under all other methods of treatment was from 
twenty-five to thirty-three per cent., he lost only 
one case. 

Believing that alcohol neutralizes the poison of 
diphtheria as it does that of the rattlesnake, he 
begins the administration of brandy or whisky at 
the outset, pushes it rapidly to the point of satu- 
ration of the system, and maintains it there. 
Quinine, or some other preparation of the bark, in 
tonic doses, and later, iron, as a blood restorative, 
together with nourishment (mainly milk with lime 
water) constitute the only auxiliaries to alcohol. 
Under this treatment he assures us the skin loses 
its heat and dryness ; the pulse becomes slower 
and stronger ; the temperature falls to the normal 
point; and the restlesness, which is a marked 
feature of these cases, gives place to peaceful rest. 
In due time the membrane loosens and falls ; the 
recuperative powers assert their sway ; and under 
a continued but more moderate use of alcohol, 
convalescence advances apace, unhindered by 
relapses, and unmarred by sequelae. 

My object is not to review this little book, which 
contains detailed reports of cases and practical 
suggestions on many points, but to bring before 
your readers this claim for alcohol, in the hope 
that those who have already tested it will be led to 
publish their results, and many to whom it may be 
new induced to give it a candid trial, and also 
report their success or failure for the good of all. 
In view of the mighty interests at stake, we are 
verily guilty if we prove remiss in the perform- 
ance of this duty, for if the wonderful results 
reported by Dr. Chapman can be but half repro- 
duced in the practice of each physician, according 
to his opportunities, how infinitely will such 
achievement diminish the sum of human woe 
throughout our land, and how grandly redound to 
the glory of our profession. 

As for myself, while not, with present experi- 
ence sanguine enough to hope that under the use 
of alcohol " ninety- five per cent, of all diphtheria 
patients can recover," I do believe that its free 
use in diphtheria is never harmful, but always 
useful, for my best results have uniformly been 
obtained through an early resort to stimulating 
and supporting treatment. 



Communications. 



IVol.xl. 



In saying this, I believe I am expressing the 
sentiment of the majority of physicians, yet obser- 
vation occasionally shows me that some, at least, 
do not suitably apprehend the depressing tendency 
of diphtheritic blood-poisoning. 

The following abstract of recent cases will serve 
to illustrate these points. On Thursday, the 14th 
instant, I was called to Concord, in this county, in 
consultation with Dr. W. N. Keeler, and learned 
the following particulars : — 

Friday, November 8th, four children in the 
same school sickened almost simultaneously. One, 
a boy, twelve years old, died on the following 
Monday night. Dr. Keeler who saw him in con- 
sultation Sunday evening, told me it was a case of 
malignant diphtheria. I was informed that this 
patient got no stimulating or supporting treatment. 

The other three cases were in the care of Dr. 
Keeler, and had, from the first, cinchonidia, tinc- 
ture ferri mur., and a moderate amount of milk 
punch, yet they all became steadily worse until 
Tuesday, when he adopted the heroic use of 
whisky. 

One of the patients, a slender girl, twelve years 
of age, developed, on Monday, the characteristic 
eruption of scarlatina in abundance, but had also 
a free diphtheritic deposit in the throat and great 
swelling of one parotid region. Another, a girl of 
seventeen, but very frail and small for her age, 
had as abundant and thick a deposit of membrane 
on palate, tonsils and fauces as I have ever seen, 
and the diphtheritic odor was so strong as to make 
it difficult to remain for any time in the room. 

The occasion of calling me was the occurrence, 
during Wednesday night, of severe croupous 
symptoms in the third patient, a boy of eleven 
years. The sharp cough, stridulous breathing, 
anxious countenance and inability to speak above 
a whisper, evidenced the development of mem- 
brane in the trachea (if not the larynx, also), 
while the tonsils and palate were covered with a 
soft gray exudate. The nasal passages were filled ; 
there had been moderate epistaxis, and I saw, on 
Friday, a piece of thick, organized membrane, IJ 
inches by | of an inch in size, which had been 
blown out through the nostril. Among several 
cases which I can recall of so severe diphtheritic 
croup, I cannot remember one which has re- 
covered. 

After Tuesday noon, each of these children took 
from four to six teaspoonfuls (from ^f to ^j) of 
the best whisky during every hour, night and 
day, yet no stimulating effects were developed. 
The skin was moist and not hot, the pulse 80 per 
minute, firm and steady, the membrane loosening, 
and the general appearance bright and encourag- 



ing. Cinchonidia, small doses of iron, and good 
nourishment were continued, and alternate inhala- 
tions of the vapor of chlorine, and of lime were 
frequently used. The two cases complicated with 
scarlatina and croup are convalescing finely. In 
the other case, improvement was marked from 
Tuesday till Saturday, when the stomach refused 
to retain anything, and death from exhaustion en- 
sued on Monday evening, ten days from the attack. 
I believe that the fact of this patient being in a 
small room with low ceiling, and difficult to venti- 
late, by serving to concentrate the poison, contri- 
buted largely to the fatal result. The attending 
physician is of the opinion that had he known 
this method of treatment, and adopted it at the 
outset, before deterioration of the blood had pro- 
gressed so far, he would have had the pleasure of 
carrying this case also to a favorable issue. 

If alcohol does act as an antidote, then mani- 
festly much of its efficiency will depend upon its 
early use, and the fever of the first two or three 
days, which is but the excitement attending 
nature's frantic efforts to guard the citadel, constir 
tutes no contraindication ; for the alcohol is so 
rapidly neutralized by the poison, that enough 
cannot be absorbed to develop its ordinary stimu- 
lating effects until the poison has been in a measure 
destroyed. Hence, we find the excitement subsid- 
ing and strength increasing " pari passu " with the 
operation of our antidote, instead of fever abating 
and strength failing, as is the case so often when 
nature, unaided by art, and becoming exhausted, 
slowly ceases to resist, and finally succumbs in the 
unequal contest. 

These phenomena may afford a good illustration 
of the antipathic principle in medicine. Alcohol 
is a poison to healthy blood and the excitement of 
intoxication but a manifestation of nature's strug- 
gle to eliminate it ; and when we see great quanti- 
ties of it taken into the circulation during the 
progress of diseases tending to septicaemia, and the 
symptoms of this struggle absent, is it not fair to 
infer that the two morbific agents are mutually 
destructive ? 

How radically is our practice changing in the 
treatment of fever, as we are learning how often it 
is not an idiopathic condition but a symptom of 
inability on the part of the life-preserving forces 
to overcome a morbid condition, or expel a mor- 
bific agent ; and indicates, not an excess, but a 
deficiency of vital force. The habit of using 
depressing arterial sedatives is giving place to the 
employment of tonic sedatives, as we learn that 
not only in continued fevers but also in the exan- 
themata, and even in many inflammatory diseases, 
a large dose of quinine (thirty grains for an adult) 



Jan. 4, 1 879. 1 



Communications, 



given at the height of the exacerbation, has the 
sweeping effect to reduce the temperature, make 
the pulse slower and stronger, promote perspira- 
tion, and produce sleep so quiet and restful as to 
preclude the necessity for other anodynes. This 
is my universal practice wherever I find a tem- 
perature as high as 102°, without regard to the 
name of the disease, and it is productive of very 
gratifying results. One marked case in illustra- 
tion occurs to me. Two years ago I was summoned 
to a child three years old, at the commencement of 
an attack of double croupous pneumonia, and 
found the skin burning hot, respiration 60, pulse 
180, and temperature 106.5°. It was one of those 
desperate cases in which the system seems over- 
whelmed by the violence of the inflammation, and 
I did not believe the little patient would survive 
the first stage. I immediately gave thirty minims 
of a solution of quinine containing half a grain to 
the minim. The disease was arrested in its begin- 
ning, and in five days convalescence was estab- 
lished. But little other medicine was administered, 
and no veratrum or other depressing sedative. In 
a disease like diphtheria, where the initiatory 
fever is so speedily followed by exhaustion, this 
sedation by quinine is eminently useful as a means 
of husbanding vitality by saving wear and tear 
during the stage of excitement. 
Novetnber IZd, 1878. 



MEDICAL TESTIMONY. 

BY ORLANDO FEGLEY, A.M., M.D., 
Of AUentown, Pa. 

Hearing the testimony of a number of physicians 
summoned as experts, to testify in a case of homi- 
cide, has suggested the following remarks : — 

The points in the case are as follows : A man 
being struck with a club on the side of the neck, 
face, or head, there being no external evidence of 
violence, falls upon his face to the ground with 
sufiicient force to detach the cartilage of the nose ; 
does not move, groan, or give any other evidence of 
life. He is left by his assailant ; twenty or thirty 
minutes afterward he is taken up dead, with a 
small clot of blood at his anterior nares. 

Fourteen hours after death two physicians make 
an autopsy ; they open the chest, look at the 
anterior surface of the lungs, feel the lungs with 
their fingers, take out the heart, cut into it, and 
close the investigation. They give the result of 
their examination before a jury impanneled by a 
country squire, and the jury finds a verdict of death 
caused by asphyxia. 

The district attorney, not satisfied with the 
verdict, calls another physician, who, fifty hours 



after death, removes the skull, and finds two clots, 
estimated to amount to about an ounce of fluid 
blood ; one-fourth of the clot being on the left, and 
three-fourths on the right hemispheres of the 
brain. What was the cause of death ? 

The principal answers given by the physicians 
to this question were : " It was compression," "It 
might have been concussion." " It might have been 
apoplexy, induced by passion and excitement.'' 
" The victim being subject to attacks of asthma, it 
might have been apoplexy caused by a paroxysm 
of asthma, which could have come on as a conse- 
quence of excitement, anger and rapidly walking 
to the scene of contention." " It was, in my opinion, 
asphyxia." " It was a mixed cause." 

The questions of scientific interest were : Does 
hemorrhage, or extravasation of blood into the brain 
substance, or upon the hemispheres of the brain 
occur in concussion of the brain, without reaction 
taking place ? Does ecchymosis of the skin occur 
from a blow where death results instantly ? These 
questions were answered in the negative, or in an 
evasive manner, leaving a negative impression, by 
all the physicians. 

Knowing the physiological fact that the heart 
propels the blood with a force of thirteen pounds, 
and the physical fact that a substance so pro- 
pelled acquires a momentum equal to its mass 
multiplied by its velocity, we consider it well 
demonstrated, not mentioning other causes, that 
though the heart's action should cease instantly 
there is momentum sufficient in the blood mass to 
cause hemorrhage, or extravasation on or into the 
brain substance, the most vascular of all organs of 
the body, if there is a rupt-ire of any of its vessels. 
If these scientific experts, divested of all their 
theories, would visit a slaughter house, they might, 
perhaps, acquire very valuable information as to 
whether there could occur hemorrhage after so- 
called instant death from concussion of the brain. 

The second question might be considered an- 
swered with the first ; but we will add that au- 
thorities on post-mortems say that blows on the 
skin of a body, not being dead more than two 
hours, may produce true ecchymosis with extrava- 
sation of blood. 

If physiology be read with care, it will be found 
that the movement of the blood in the capillaries 
may continue after cessation of the heart's action ; 
if not, how account for the left side of the heart 
and arteries being empty several hours after death. 
It further teaches us that after death urine may 
be poured out by the ureters, sweat exuded from 
the skin, and other secretions formed by the 
glands, all of which must be due to a continuation 
of the capillary circulation after death. The only 



8 



Hospital Reports. 



[Vul. x\. u 



reason why medical witnesses so frequently com- 
mit such inexcusable errors as they do in giving 
testimony in courts of justice, is, that instead of 
taking the facts as found, they form theories, and 
by means of authorities attempt to support their 
theories, until they finally convince themselves of 
the correctness of their opinions. They will read, 
take notes, commit pages of standard works, with- 
out apparently ever stopping for a moment to 
think or reason. They will go before a jury and 
recite section after section of Carpenter's physi- 
ology, on respiration and circulation, if not inter- 
fered with by the court ; all of which is as intelli- 
gible to the average juryman as the reading of a 
paragraph of Homer's Iliad or Virgil's ^neid in 
the original would be. 

As long as the questioning attorney confines 
himself to the lesson thus learned, the doctor 
makes a great display of medical learning, and 
were no other questions to be asked, he would step 
from the witness stand triumphantly ; but, like 
the school boy, as soon as the lesson learned has 
been recited, he is done. When plain, straight- 
forward questions are put, he will be very careful 
to answer them by saying, " It is possible," " It 
is probable." " It is highly improbable." And after 
having answered a dozen or more questions in this 
way, he will conclude by saying, " This is an 
exceedingly rare case." 

True, the ease may be a rare one. There are 
no two cases alike ; each case has its individuality, 
just as each man or woman have their individu- 
ality, yet they have points in common with all 
mankind. 

Upon the points which a certain class of cases 
have in common, authorities can be found, and 
may be cited. Upon the points which give the 
cases their individuality no authorities can be 
found, and, consequently, reasoning from the facts 
must be resorted to, and if nothing can be shown 
to the contrary, the conclusions so formed must 
hold good. 

Should not the so frequent discomfiture of phy- 
sicians on the witness stand be a warning to the 
profession, that instead of forming theories, and 
allowing themselves to become coached witnesses 
in support of such theories, they do more careful 
reading, and, as a consequence, more intelligent 
thinking and correct reasoning ? 



— The growing sentiment in favor of recognizing 
woman's ability to practice medicine successfully 
is attested in the action of the Cincinnati Academy 
of Medicine, which has just admitted Mrs. Dr. 
Julia Carpenter to full membership. She is the 
first of her sex to receive this mark of appreciation. 



Hospital Reports. 



HOSPITAL OF THE UNIVEESITY OF 
PENNSYLVANIA. 

CLINIC OF PROF. WILLIAM PEPPER, A.M., M.D. 

Reported for the Medical & Surgical Reportbb, 

by Charles A. Olivkr, a.m., m d., late Resident 

Physician, Philadelphia Hospital. 

Rachitis. 

Gentlemen : — I have here two colored children, 
in whom I shall show and explain to you well 
marked rachitic lesions and symptoms. Rachitis 
is essentially a disease of childhood, most fre- 
quently seen from the latter half of the first year 
until the period of second dentition. The causes 
being bad hygienic condition and improper nu- 
triment, as, for instance, continued exposure to 
damp and cold ; nursing from a weak, impover- 
ished mother ; artificial nourishment, etc. 

The disease is principally one of the osseous 
system, although the entire nutrition suffers. 

We find, as one of the earliest symptoms, the so- 
called beading of the ribs, dependent upon cartila- 
ginous enlargements at the junction of the bone 
and cartilage. In both these cases, nearly all the 
ribs are so nodulated. The other long bones next 
suffer, their epiphyseal junctions having a bulbous, 
swollen look, more marked in the bones of the 
lower extremities, and at their distal ends. In these 
subjects we find it well displayed in the fibula and 
tibia. 

Later in the disease, bony elevations appear along 
the sutural lines of the cranial bones, accompanied 
by localized defects of ossification, the so-called 
" soft spots," which are apparently due to resorp- 
tion of the osseous salts. These lesions are not 
noticeable in either of the children I have here, 
and I think the frequency of the latter lesion, the 
*' soft spots," has been exaggerated. 

The deformities which result from the pressure 
of the body on the softened bones, as well as the 
subsequent induration which the bone undergoes, 
are well exhibited by the curving seen in this 
child's legs, the femoral shafts being almost 
sabre-shaped. 

In the second child, we notice well-marked 
spinal curva ure, consequent upon pressure. Here 
is a rachitic skeleton, which beautifully shows the 
extreme osseous lesions of rachitis. Besides those 
I before mentioned, you see that the skull is un- 
usually large, but vastly differing from one from a 
case of hydrocephalus, in the fact that the rachitic 
skull is heavy, with large, square forehead, unusu- 
ally marked protuberances and ridges of thickened 
bone along the sutures. The result is, that the 
vault is not expanded, the sutures and fontanelles 
being closed without any supernumerary bones. 

About the earliest general symptom, is marked 
digestive disturbance, diarrhoea alternating with 
constipation, accompanied by restlessness at night, 
and profuse sweatings about the neck and head. 
Sometimes, in acute cases, there is febrile action. 
Such patients are sore to the touch, and averse to 
locomotion. 

If we meet these symptoms, we should carefully 
examine for early rachitic changes in the bones. 



Jan. 4, 1879.] 



Hospital Reports. 



If there is no rheumatism, suspect rachitis. If the 
child be improperly nourished, pale and weak, 
place it upon good diet — milk, eggs and broth. 
Give plenty of fresh air. Cod-liver oil exerts 
almost a specific curative effect, and should always 
be exhibited ; it is best given in an emulsion with 
the phosphatic salts. If the child be antemic, 
combine the use of iron the most efficacious form 
being the syrup, ferri iodid. 

It has been frequently stated that one-fifth or 
even one-fourth of the children of European citie.^ 
are rachitic, but I trust that this statement is an 
exaggeration. In America, the disease is certainly 
much less prevalent in the cities, and almost un- 
known in rural districts. It is, however, quite 
frequently met with in its less severe and marked 
forms, and demands prompt recognition and treat- 
ment. Of itself, it is not fatal, but has great ten- 
dency toward grave complications. 

Tonsillitis. 

This man, a laborer, a few days ago suddenly 
had a chill, followed by high fever, and within 
twenty-four hours complained of sore throat. I 
see he has herpes labialis ; this is an interesting 
eruption. It occurs very commonly at the crisis 
of febriculse, and is also very common after ma- 
larial paroxysms. In the present case no malarial 
history is given. 

Upon examination, I find that he has slight en- 
largement of the glands at the angles of the jaws. 
Tonsils red, swollen, and engorged, with absence 
of any pseudo-membrane ; uvula swollen and 
elongated, and in close contact with the right 
tonsil. Consequently, from this group of symp- 
toms, we see that he is suffering from an ordinary 
simple acute tonsillitis. 

We continually meet it in its difierent forms, 
painful, but easily managed. 

There are three principal varieties : — 

First. Simple, acute, diffused, tonsillar inflam- 
mation. The tonsils being red, enlarged and 
swollen, with no pseudo-membrane or follicular 
enlargement. 

In the second variety, we not only find the 
tonsils engorged, but also their surfaces dotted 
with whitish points, which are the distended 
follicles, and are to be carefully distinguished from 
membranous exudation. 

The third, or phlegmonous form, is character- 
ized by most violent inflammation of the entire 
tonsil. It usually affects one tonsil principally, 
though after one has suppurated, the other may be 
attacked. The gland is enormously swollen, tense, 
red and painful. Deglutition is frequently impos- 
sible. 

All varieties of acute tonsillitis are usually 
attended by marked constitutional symptoms. In 
children they may even be ushered in by convul- 
sions ; whereas, in adults, as in this case, chills 
constitute the precursory sign. The fever which 
follows may be very intense, the temperature not 
rarely reaching 103°, or even 105°. The pulse is 
rapid, though in children not as much so as in 
scarlatina. 

The local symptoms are dryness and severe pain 
in the fauces, a sense of obstruction, leading to fre- 
quent and very painful attempts at swallowing, 
difficulty of deglutition, which rapidly increases, 
until, in the phlegmonous form, it becomes im- 
The voice is nasal and smothered. 



The treatment in acute tonsillitis varies with 
the form. In general, it may be said that the 
most useful remedies are guaiacum, iron, chlorate 
of potassium and quinia. Guaiacum is especially 
valuable in the follicular form, where, indeed, it 
sometimes acts with almost specific effect. It is, 
however, useful in all varieties. It may be given 
in doses of three to five grains, in emulsion or in 
lozenge, repeated every three hours. So too, in 
all the varieties of acute tonsillitis, I am in the 
habit of giving iron in large and frequently re- 
peated doses. The preparations which seem to 
me to be the best in these cases, are the tincture of 
the chloride and the solution of the perchloride. 
The latter is very well taken, even by children, if 
diluted with syrup of lemon or ginger. The doses 
I employ are twenty-five to thirty-five drops every 
two or three hours for adults ; and for children, 
proportionally large amounts. 

These large doses of iron may appear heroic, 
but it is surprising how wonderfully well they are 
borne, and of how much value. 

For an average case, we can make a formula as 
follows — 

R. Quini?e sulph., gr.xxxvj ; 

Potass, chlorat., ,^ij ; 

Tr. ferri chlorid., fl.fss; 

Syrup, limonis, q.s. ad. fl^iij. 
M. Et fiat sol. 

SiG — A teaspoonful, freely diluted, and taken 
through a tube, every three hours. 

There are two reasons for using a tube ; first, the 
muriatic acid acts on the dentine, and secondly, 
the drugs are more slowly swallowed, and hence 
produce better local effects. 

I may remark that the reason that the treatment 
of diphtheria, and of the membranous angina of 
scarlatina, by quinia, chlorate of potash and iron, 
does not more uniformly succeed, is largely due 
to the fact that the iron is not given in sufficiently 
large doses. 

Topical applications are also necessary. The 
ones I have found the most efficacious are, either a 
forty -grain solution of nitrate of silver, or a mix- 
ture containing equal parts of tr. ferri chlor., gly- 
cerine and water. 

In the phlegmonous form none of these reme- 
dies will, as a rule, prevent suppuration. The 
attempt should be made by the above means, and 
by the local use of iodine externally over the seat 
of the tonsillar glands. If the inflammation pro- 
gresses, suppuration should be encouraged by hot 
poultices, and as soon as palpation reveals fluctua- 
tion in the tonsils, we should immediately incise 
and allow the pus to escape. 

It is also extremely important, especially in 
feeble persons, to remember that if dysphagia in- 
terferes seriously with taking nourishment, nu- 
tritious enemata should be administered. 

[The patient was placed on the prescription 
above given, solution of nitrate of silver, gr. xl to 
fl^j, was applied locally, and rapid recovery fol- 
lowed.] 



— The Vanderbilt University, Nashville, Tenn., 
has dismissed Dr. Winchell, because he believes 
the doctrine of evolution ! And the Methodist 
Episcopal Conference, of East Tennessee, has en- 
dorsed the action. The world moves, however, in 
spite of bigots. 



10 



Periscope, 



[Vol. xl. 



Editorial Department 



Periscope, 



Resection of Several Joints in the Same la- 
dividaal. 

This case, which occurred in the practice of Dr. 
M. Schede, is reported in the Deutsche Zeitschrift 
fiir prakt. Medizin, No. 20, 1878. The patient, a 
girl, aged nineteen, had suffered for four years 
from rheumatism of several joints, which ran 
a rather acute course, and finally led to the forma- 
tion of ankyloses. There was bony ankylosis of 
both wrists and elbows, both knees and ankles ; 
most of the phalangeal joints were also stifi". 
Most of the joints, with the exception of the 
wrists, were much thickened. The patient wa^ 
thus in a state of complete helplessness. Within 
four months, Dr. Schede performed resection of 
both wrists and elbows, as well as both ankles. 
At the time of the report, both wrists were mov- 
able ; so also were the elbows, but one had already 
become more stiff, and threatened ankylosis. 
There was limited power of motion in the ankles. 
The course of the case showed that a better result 
in regard to active and passive motion follows 
when the resection is extensive, than when a small 
piece of bone is removed. This depends, probably, 
on the fact that the disposition to the production 
of bone and the formation of ankylosis, which in 
some such patients remains very great, continues 
even after resection. The patient in this case had 
every reason to be satisfied with the improvement 
in the utility of her limbs. After her recovery, 
she could assist her walking by crutches, whereas 
she could not use them before ; she could also r.se 
her hands in feeding and clothing herself, which 
previously was quite impossible. 



Tapping the Lungs in Phthisis. 

At a recent meeting of the Clinical Society of 
London, Dr. Theodore Williams communicated a 
case of bronchiectasis and lung excavation, in 
which an attempt was made to drain the cavity by 
tapping. 

The patient, a man aged twenty-nine, had 
chronic pneumonia of both lungs, resulting in per- 
fect resolution in one, and in induration and dila- 
tation of the bronchi in the other. He subsequently 
had haemoptysis to the amount of three pints, and 
lost two stone in weight. When admitted into the 
Brompton Hospital, in May, 1877, the symptoms 
were convulsive cough and fetid expectoration, 
containing large quantities of lung tissue, and so 
offensive in character as to cause frequent vomit 
ing. ^ There was also con-iderable pyrexia. The 
physical signs denoted consolidation of the base of 
the left lung, with commencing excavation. During 
his stay in the hospital the area over which cavern- 
ous sounds were audible increased considerably. 
Various kinds of treatment were tried, to relieve 
the cough, and to facilitate and disinfect the ex- 
pectoration, but all with only temporary benefit ; 



and as the patient appeared to be poisoned more 
and more by the retained expectoration, and ex- 
hausted by the cough, on October 16th, 1877, a 
medium-sized aspirator needle was passed between 
the eighth and ninth ribs, in the area of the 
cavernous sounds, and appeared to reach the cavity, 
but on exhaustion only a few drops of blood fol- 
lowed the operation and the puncture was subse- 
quently closed with lint. The patient afterward 
suffered pain in the infra-mammary region, but as 
his symptoms continued to increase, a fortnight 
later a second attempt was made to reach the 
cavern ; this time the intercostal space below the 
scene of the first operation being selected, and a 
trocar and large drainage-tube being introduced. 
On reaching the pleura a pint of brownish, fetid 
fluid escaped, which proved under the microscope 
to consist of broken-down pus cells. Symptoms 
of collapse followed the evacuation of the fluid, 
and the patient was with diflSculty rallied with 
stimulants. The abscess was washed out with dis- 
infectants, but no improvement took place, and 
the patient gradually sank, three days after the 
operation. 

On post-mortem examination it was found that 
the lung contained a labyrinthine cavity formed 
by the breaking down of the walls of several 
dilated bronchi, one of which had been penetrated 
by the first operation. Overlying the cavity was a 
limited empyema, which the second operation had 
evacuated. The right lung was affected by recent 
pneumonia, the re=ult of infection through inhaled 
secretion from the left, this being the immediate 
cause of death. 



Calculus Vesicae with a Hair-pin as its Nucleus. 

A repoH from St. George's Hospital, in the 
British Medical Journal, gives the following curious 
case. A fairly nourished but rather ansemic look- 
ing girl, aged 19, came to the hospital on account 
of incontinence of urine. Seven months previ- 
ously she was suddenly seized with acute abdom- 
inal pain, which passed off in thirty-six hours. 
Such attacks recurred seven or eight times. She 
also said that, for two months before admission to 
hospital, she had suffered much pain in the epi- 
gastrium and left flank, and occasionally passed 
blood in the urine. During the spasmodic attacks 
of pain, urine had run away. On examination, 
the urine was found to be alkaline, with copious 
deposit of pus. A probe passed into the bladder 
detected a hard mass, and on withdrawing it, 
brought away a little phosphatic matter. The 
finger in the vagina detected two sharp points, ap- 
parently those of a hair-pin, projecting backward 
through the vesico- vaginal septum ; around this a 
large round mass was felt in the bladder. 

Ether was administered, and on introducing a 
duck-bill speculum, the black points of the pin 
were seen projecting through the wall of the blad- 
der into the vagina about a quarter of an inch. 
The calculus proving too large for extraction by 
the urethra, Mr. Pollock made a transverse inci- 



Jan. 4, 1 879. 1 



Periscope, 



1 1 



sion between the projecting points, through the 
vesico-vaginal septum, one inch and a half in 
length. So rapidly did this opening contract, that 
it was subsequently found necessary to enlarge it 
twice. Much difficulty was experienced in ex- 
tracting the hair-pin, on account of the points catch- 
ing in the bladder-wall, so it was broken at its 
bend, and the two halves were then extracted 
without difficulty, and the phosphatic matter was 
scooped away. The mass had probably been as 
large as a hen's egg. The bladder-wall was about 
half an inch in thickness. The wound in the 
bladder was closed horizontally with thin silver 
sutures, and a flexible catheter was tied in the 
urethra. No constitutional disturbance followed. 
A fortnight later the sutures were removed under 
ether, the wound being healed, except where the 
pin had previously caused ulceration. The edges 
of this sinus were subsequently pared and brought 
together. 

Suggestion for Treating Swollen Fingers. 

A correspondent writes to the Medical Times and 
Gazette^ London — 

Allow me to suggest to your readers the use of 
the material in the treatment of the swellings of 
the fingers, which are often tedious and painful, in 
persons of rheumatic or gouty constitution. 

For two or three years past'I have used a piece 
of an india-rubber finger-stall in fissures and slight 
cuts of the fingers ; and for twelve months or more 
I have used it in cases of thickening or deposit 
around the joints of the fingers after injury, with 
great relief to the patient. It has seemed to me 
that the brown finger-stalls of pure rubber are 
better than the black or vulcanized. 

A piece of tubing may be cut into lengths of 
about an inch or an inch and a half. One of 
these can be slipped over the joint by the patient 
himself, after he has been taught how to do it. It 
should be worn constantly, day and night. The 
patient will soon learn how to roll it off", and re- 
apply it after washing his hands. When it has 
become too loose to give the necessary support 
another length can be taken. 



Studies on Diabetes Mellitus. 

In some studies on this disease, published in the 
Archwfiir Klinische Med., Dr. Tiirbringer deduces 
that the greater the relative amount of sugar the 
more favorable is the prognosis; that a remedy 
which increases the glycosuria does the less harm, 
as it increases the relative amount of sugar ; and 
lastly, that a remedy which does not alter the gly- 
cosuria is useful, as it increases the relative amount 
of sugar. ^ In the first two cases the increase is due 
to a diminished excretion of nitrogen ; and the 
drugs which did good by this means were salicy- 
late of soda (8 to 10 grammes = 120 to 150 grains 
a day) and carbolic acid pills three times a day ; 
quinine, arsenic acid, pilocarpin, and benzoate of 
soda, gave no definite result ; thymol, oil of tur- 
pentine, digitalis, and bromide of potassium did 
harm, and are therefore contraindicated in dia- 
betes. 

Two cases of the disease are reported by Dr. 
Eugene^ Zarzana, in the Gazetta Medica di Roma, 
quoted in The Doctor, The first patient, a woman, 



had been passing a large quantity of water for 
three years ; she was very weak, her sight was 
affected, and her thirst was great. At the time the 
treatment was begun she was passing twelve 
Roman livra of urine in the twenty-four hours ; it 
was not albuminous, but contained a large quan- 
tity of glucose. At first she was given daily three- 
quarters of a grain of the alcoholic extract of nux 
vomica, dissolved in three ounces of distilled water, 
and the dose was increased by three-quarters of a 
grain every three days, until she was taking 4^ 
grains per diem. Under this treatment the quan- 
tity of urine diminished, and it became very acid, 
flocculent, and colored by biliary pigment. At the 
same time glucose diminished until only traces of 
it could be discovered. The general symptoms 
improved, and the patient was restored to her pre- 
vious good health. The second patient was a 
large, robust man, seventy-two years of age. 
During eleven hours he passed two Koman livra 
and eight ounces of urine, which was rich in 
urates and albumen. Under the use of the nux 
vomica, the glucose gradually diminished in quan- 
tity, and finally disappeared entirely. 



Positional Treatment of Uterine Inflammation. 

Dr. Graily Hewitt says, on this subject [Medical 
Press and Circular) — 

This is of the utmost consequence in all cases, 
difficult or not difficult. In slight cases it is alone 
sufficient. This is most important. Bearing in 
mind the circumstance that the subjects of these 
cases are not unfrequently young unmarried women 
in whom local explorations, and the application of 
internal local treatment are, if possible, to be 
avoided, it is very satisfactory to know that a 
rational treatment of slight uterine displacement, 
and commencing uterine distortion, can be carried 
on without recourse to these procedures in cer- 
tainly the large majority of such cases. It is, of 
course, different when the malady is of long dura- 
tion, and the uterus has been, perhaps for some 
years, in a very diseased state. 

One or two instances may be given in illustra- 
tion of these remarks. A young lady, much ad- 
dicted to dancing, had not menstruated for nearly 
a year. No examination was made, but a diag- 
nosis of probable commencing anteflexion was 
arrived at. The patient was ordered to maintain 
the horizontal dorsal position absolutely, for two 
months. At the end of one month menstruation 
reappeared, and the case subsequently ended quite 
satisfactorily. Some years ago I was consulted in 
the case of a young lady who had been allowed to 
over-exert herself in many ways, who had been 
much under-fed, and in whom menstruation had 
ceased for a long period. The horizontal position, 
and great care in the matter of dietary, produced 
a comjdete restoration to health. Since that time 
other membeis of the same family have exhibited 
like tendencies, and the same symptoms have been 
combated with the same simple remedies, with 
perfect success, though, from what I know of the 
history of similar cases, it was evident to me that 
there was decided mechanical disturbance of the 
uterus present, such as would, if neglected, have 
led in process of time to more Serious results. No 
examination was made in either of the cases. 

The horizontal position is the great desideratum. 



12 



Periscope, 



Vol. xl. 



The diflficulty is to know whether the dorsal or 
prone position is the proper one. The lateral 
position may often be accepted as a compromise 
when this is uncertain. The symptoms generally 
indicate the proper course, and, forward displace- 
ments being much more common, the doi-sal or 
lateral position is generally necessary. 



Iodoform as a Local Ansesthetic. 

In a recent article in the Winer Med. Wochenschrift, 
Dr. Moleschott says he has often relieved or re- 
moved the most intense gouty pains and other 
symptoms of gouty inflammation within twenty- 
four hours, by painting on the collodion. In rheu- 
matic pains it is less efficacious, but in the various 
neuralgias (intercostal, sciatic, etc.) it succeeds 
excellently. Unfortunately, as most people know, 
iodoform has a disagreeable smell, which makes 
those using it at times objectionable to others. To 
obviate this, Moleschott advises that the glass 
vessel containing the iodoform preparation (col- 
lodion, or, what he also uses, ointment) be kept out- 
side the window, in a leaden box provided with a 
well-fitting cover, the opacity of the box having 
the additional advantage of retarding the de- 
composition of the iodoform by light. He also 
covers with gutta-percha tissue the part anointed 
with the collodion ; and, if possible, only applies 
the iodoform at night, so that most of it is ab- 
sorbed, or has evaporated, before the morning, 
and what remains (if the ointmant is used) can 
easily be removed with soap and water. The use 
of iodoform sometimes causes cardiac palpitation, 
but Dr. Moleschott has also more than once found 
a weak, irregular pulse rendered stronger and 
more regular by small internal doses of iodoform, 
just as by small doses of digitalis. 



Malignant Gastro-Enteric Dysentery. 

The following abstract of a report on this dis- 
ease in Bergen Co., New Jersey, from August 15th 
to November 1st, 1877, is furnished by Dr. Clen- 
denin : — 

It was mainly endemic to the sewer-fed and low 
localities, when densely populated, as in the Engle- 
wood Valley Bottoms. The constant presence in 
patients' excrement of vermicules, could be traced 
as coming from the so-called wells, viz., receiving 
holes for the drainage, not only from the hill set- 
tlements, but of the results of putrefactive ferment- 
ation and germination, from immediate surface, 
slops and offal matter; 1877 being the second 
consecutive extra dry season, and there not having, 
therefore, been enough rain to cleanse the surface, 
earth and wells. 

Prominent among the vermicules was the aga- 
monema capsularia ; Diesing, described by Prof. 
Joseph Leidy, of the University of Pennsylvania, 
in Proc. Acad. Nat. Sciences, Phila., 1856. In 
a letter to me he speaks of this parasite as being 
"found in shad, herring and other fish, which 
latter should be so cooked as to prevent transmis- 
sion," and says he has " found them on tlie roe of 
the salted herring," and noted their " impover- 
ishing power to shad, when many are found there- 
in. In such cases I have always found shad pale, 
anaemic, and the vermicule showing its sanguinary 
taste from the fact of being always found encysted 



immediately contiguous to a blood vessel, and 
when found in blood loaded tissues, as the liver, 
for instance, coagula will be found surrounding 
the encyst. The vulgar habit, in such village 
localities, of throwing the fish scrapings and other 
refuse matter upon the yard, carries, in such .seasons 
especially, more danger than exists in cooking, 
where fire oflfers an immediate remedy. The fact 
that these vermicules are found in the fish taken 
from the creek, which receives the drainage of the 
town, whereas they cannot be found in the fish 
taken from the brooks which are near by, but fed 
by gravel spring and mountain water, shows that 
they are of ofifal origin. 



German Treatment of Croup and Diphtheria. 

The following treatment of croup and diphtheria 
is advocated by Dr. Taube, in the Deutsche Zeit- 
sehrift fur Prakt. Medicln, September, 1878. An 
ordinary inhaler is to be taken, full of water, into 
which is to be put each time it is used fifteen drops 
of the oil of turpentine. The child should be 
wrapped in a sheet and placed on its mother's lap, 
while another person holds the apparatus for eight 
or ten minutes, about three inches from its mouth. 
It is as well to grease the child's face and to pro- 
tect the eyes with a cloth. At first the inhalation 
should be practiced' every hour, day and night, the 
favorable result of which will soon be apparent. 
With regard to the carbolic acid injection, it 
should be made into the submucous tissue, half the 
contents of an ordinary hypodermic syringe, con- 
taining a weak solution of the acid (3 to 1000) 
being injected two or three times a day into the 
tonsils. Subject to certain modifications, as the 
case may require, Taube would recommend the 
following plan : 1. Hourly inhalations of the oil of 
turpentine throughout the day and night. 2. In- 
jection of carbolic acid two or three times a day. 
3. From one to two teaspoonfuls of Port wine or 
Madeira, to be given every hour ; cold compress to 
the neck ; two or three times a day a warm bath 
with the cold affusion ; and small doses of the in- 
fusion of digitalis, to which a little benzoic acid is 
added. The nourishment should consist of eggs 
and milk only. Constipation is to be met with 
linseed oil, and for the separation of the false 
membrane, sulphate of copper, or racheotomy, with 
turpentine inhalations through and above the 
canula. 



Some Therapentio Uses of Alcohol. 

Dr. G. Timins, in the Medical Press and Cir- 
cular, says, on this subject — 

To dilate the arterial system is the chief thera- 
peutical use of alcohol, as well as its most import- 
ant physiological action. By relaxing arterial 
contraction the circulation is immediately modi- 
fied. The greater proportion of the blood being 
in the arteries, the whole venous system is relieved, 
less blood is sent to the lun^s, less force required 
in the heart, and the circulation for the time made 
easier. Coldness of surface, lividity of complexion, 
oppressed respiration, and feeble or laboring action 
of the heart (collapse) are accompaniments and 
symptoms of a preponderance of blood in the 
venous system, and are indications for the use of 
alcohol. In sadden cases of collapse, if the patient 



Jan. 4, 1879.] Reviews and Book Notices. 



cannot swallow he should be made to inhale ether 
by the clothing about his nose and mouth being 
saturated by that substance. Then diluted alcohol 
may be injected into the bowel. 

Local passive congestion, so frequent and dan- 
gerous in the course of debilitating diseases and of 
convalescence, requires local treatment, but this 
will be much aided by, and often unsuccessful 
without, the cautious administration of alcohol. 

In pneumonia, intercurrent or sequent of fever, 
the exanthems, severe injuries and operations, 
general bloodletting and antimony are inadmissi- 
ble, and aconite is dangerous. In such cases 
alcohol, given to the amount of half-an-ounce of 
proof spirit (for an adult) every three or four 
hours, will be found a useful help to local deriva- 
tion. Also, after the subsidence of a sharp attack 
of pneumonia in the healthy, when the diet re- 
quires most careful watching, and the return to 
ordinary food to be made most gradually, the 
advantage of saline expectorants will be much 
increased by alternating them with moderate doses 
of alcohol. 

In fever, snake bite, and other states in which 
the powers of life seem oppressed by blood pois- 
oning, the free use of alcohol, by antagonizing 
venous congestion gives time for curative measures 
to be employed. 

On the other hand, in all inflammations, except 
during the stage of collapse, and in pneumonia, 
which is rather an active venous congestion than 
an inflammation, in all inflammations in the active 
stage, the use of alcohol is contraindicated. In- 
deed, if there were such a remedy, a drug which 
acted in the directly contrary way to alcohol, one 
producing a preponderance of blood in the veins, 
would be indicated in inflammation. 



refutes itself, by omitting cognizance of the condi- 
tion on which depends the supply of material 
from the blood for the maintenance of the in- 
creased activity of cell multiplication constituting 
' proliferation.' By disallowing vascular conges- 
tion as an all-important stage in the inflammatory 
process, the doctrine of proliferation supplies a 
plausible argument against the necessity of blood 
letting, easily admitting, however, of being dis- 
proved by clinical observation and experience." 



The Bevival of Venesection. 

The restoration of this " lost art " is attracting 
the attention of our professional brethren in Eng- 
land. A recent editorial in the Medical Press and 
Circular says — • 

There are many reasons why the partial revival 
of bloodletting should be, under certain circum- 
stance, a rational practice. On a former oc- 
casion we asked whether we are sure that the 
pathological doctrines which we are now taught, 
and to which we are told the overthrow of 
the old practice of bloodletting is to be mainly 
ascribed, are firmly established, and are to be 
reckoned among our most unassailable scien- 
tific truths ? Are we sure that the pathology of 
which we have formed so high an opinion may 
not be leading us into error with regard to our 
abandonment of a practice in which formerly so 
much confidence was reposed ? Are we sure that 
inflammation is nothing more than a manifestation 
of perverted nutrition — a morbid condition of the 
nutritive functions of the part affected To these 
questions we have an authoritative answer from one 
who can speak from experience on the subject, 
elucidated by scientific observation as to the 
pathology of the inflammatory process generally. 
"The doctrine," remarks Prof. Wharton Jones, 
" that the inflammatory process consists merely in 
'proliferation' virtually ignores the vascular con- 
gestion and the symptoms depending on it,, such 
as rvhor cum calore et dolore. The doctrine thus 



Reviews and Book Notices. 

notes on cueeent medical 
liteeatuee. 

A paper on the artificial feeding of infants 

was contributed to the last volumne of the Transac- 
tions of the New Jersey State Medical Society, by Dr. 
A. Clendenin, which he has reprinted, with cuts, and 
a description of the apparatus he employs. As long 
as so many people insist on using an artificial in- 
stead of the far superior natural article of food for 
babies, they may as well have the most improved 
apparatus ; and this of Dr. Clendenin' s, though 
rather complicated, seems to avoid various diffi- 
culties not previously overcome. 

Dr. W. E. BuUard reports, in a reprint from 

the New York Medical Journal, a, successful case 
of intravenous injection of milk. The case was 
one of gastric ulcer, apparently, the immediate 
demand for the operation arising from excessive 
hematemesis. Under an exclusive milk diet he 
recovered. We have heard of one or more un- 
successful cases of intravenous injections of miik 
in this city, but we have not observed any pub- 
lished reports of them. 

Dr. McArthur, of Lynn, Mass., has sent us 

a pamphlet containing extracts from various 
writers, showing the value of the hypophosphites 
in the treatment of phthisis. We believe Dr. 
McArthur manufactures a line of hypophosphites. 
There is no doubt but that they are often valuable 
in early stages of some forms of phthisis. But 
this pamphlet of the doctor's would have been 
more to our taste, more valuable to the profession, 
and more worthy a member of the Massachusetts 
State Medical Society, if it had defined when, 
where and how the hypophosphites are valuable, 
and when hurtful or useless. Indiscriminate 
praise, especially of a remedial agent, is always 
unpleasant because it is always incorrect. 

Dr. John B. C, Gazzo, of La Fourche 

Parish, La., has had an ample experience in 
yellow fever epidemics, and has combined the 
results of that experience in a pamphlet (pub- 
lished by M. F. Dunn & Bro., New Orleans) 



»4 



Reviews and Book Notices, 



fVol. xl. 



entitled " Yellow Fever ; Facts as to its Nature, 
Prevention and Treatment." His essay contains 
a number of interesting facts, gives his own treat- 
ment in full detail, and concludes with the cheer- 
ing assurance that " yellow fever is not, after all, 
a very serious disease to treat. To many experi- 
enced physicians it is one of the easiest to cure ; " 
statements which, just at this time, in view of the 
medical history of the last six months, have a ring 
about them which must sound strange to many an 
old practitioner who has been laboring in the 
" fever districts." 

One of the most praiseworthy charities in 

this city is the State Hospital for Women and 
Infants, 1718 Filbert street. Its annual report, 
lately received, shows eighty-five confinements, 
among which there was no case of still birth and 
no deatti of a patient ; truly a singularly satisfac- 
tory record. Moreover, most of the mothers have 
been led to correct and useful lives. The report 
says : — 

" It seems necessary once again to correct a mis- 
apprehension growing out of the name. State Hos- 
pital, that we are in receipt of State aid, which, we 
regret to say, is not the case. The name implies 
simply that the benefits of the institution are 
shared by residents of any part of Pennsylvania. 

" We have had to contend with no small amount 
of prejudice and opposition, based on ignorance of 
our objects, from well-meaning people, who feared 
that such an institution would prove an encourage- 
ment to wrong doing. Happily, a better under- 
standing has been reached by the community, and 
the Board feels that the time has come for an 
effort to provide a building adapted to their needs, 
and to relieve themselves from the burden of 
rent" 

Dr. J. G. Kerr who for twenty-three years 

was medical missionary at Canton, China, gives, in 
a short paper published by A. L. Bancroft & Co., San 
Francisco, a sketch of the progress of medical mis- 
sions in Asia and Africa. We have at various times 
called attention to this thoroughly practical and 
beneficent form of charity, and it is to be hoped 
that the plain and interesting statement of Dr. 
Kerr will awake renewed endeavors to send medi- 
cal missionaries more extensively than has hitherto 
been done. 

In a reprint from the Virginia Medical 

Monthly, for October, Dr. L. Duncan Bulkley, of 
New York, gives some carefully presented observa- 
tions on diet and hygiene in diseases of the skin. 

The advantages of the oleate of mercury in 

opthalmology are briefly set forth by Dr. M. Lan- 
desberg, of this city, in a reprint from the Monats- 
blattfur Augenheilkunde, September, 1878. 



In a reprint from the New York Medical 

Journal, Dr. John Byrne, of Brooklyn, describes 
a case of acute puerperal inversion of the uterus, 
and also a new instrument successfully employed ; 
with remarks on the mechanism of restoration. 



BOOK NOTICES. 

Organic Materia Medioa and Pharmacal Botany. 

By L. E. Sayre, ph.g. Published by D. G. 

Brinton, 115 South Seventh street, Philadelphia. 

pp. 220. Price $2.00. 

This interesting treatise on vegetable and 
animal drugs contains a vast amount of informa- 
tion in a very little space. It is at once made clear 
to the reader that unnecessary detail is scrupu- 
lously avoided, and yet it does not want in clearness 
and roundness of expression in giving the sources 
(botanical and geographical), description, chemis- 
try and pharmacology, of each substance treated 
upon. Not only are all the officinal drugs men- 
tioned, but many of the new articles which have 
come recently into market, which are destined to 
become prominent in our materia medica, are also 
brought within its pages, and are defined in clear 
and concise terms. It is evident this work is well 
fitted for the student of medicine as well as phar- 
macy ; not a line in it is without importance to 
either student. 

The classification is excellent. Drugs are 
divided and subdivided in such a manner that 
even in studying the classification one becomes in 
a great measure familiar with a good deal of detail 
concerning the subject which is made so interest- 
ing. 

The book begins with a chart of botanic materia 
medica, which gives in a convenient tabular form 
the following points concerning the drug : natural 
order of the plant, officinal name, botanical nam », 
common name, habitat, constituents, medical pro- 
parties, dose and officinal preparations. This chart 
occupies about sixteen pages; not an officinal 
drug seems to be omitted. 

It is well to mention here that the botanical 
source, as well as the constituents, are given, accord- 
ing to latest authorities ; for example, the source 
of the true Pareira Brava is given as chondoden- 
dron tomentosum ; the constituents of gentian are 
given as gentio-picrin and gentisic acid. Veratrum 
is said to contain jervia and veratridia, etc. 

The chart is followed by a geographical group- 
ing of materia medica, in which representative 
drugs from different parts of the whole world are 
displayed. In the botanical section which follows 
very many points of structural and systematic 



Jan. 4, 1879.1 



Reviews and Book Notices, 



IS 



botany are touched, and a clear bird's eye view is 
taken. The plan is as ingenious as instructive. 

The chapter upon natural orders contains the 
principal points in the description of all of the 
prominent natural orders of the plants furnishing 
officinal drugs. 

As an example of the clearness of description 
adopted by the author, illustration can be taken 
from the pages following, which are devoted to 
characteristics of drugs. In the chapter on leaves 
this point is possibly more forcibly demonstrated 
to the best advantage, being divided as follows — 

1. Margin entire, 3. Margin lobed, 

2. " toothed, 4. Leaves ternate, 

5. Leaves bi, or tri-pinnate, 
when subdivided according to their physical pro- 
perties, etc. 

Two tables complete the work — a table of the 
alkaloids and a table of antidotes and incompatibles. 
It may be said of the former that it contains all of 
the officinal and most of the prominent alkaloids, 
and gives in a tabular form interesting points con- 
cerning them not heretofore compiled together. 

The whole work displays evident ability, and as 
a convenient manual of reference to indigenous 
and general medical botany cannot but be highly 
prized. 

Transactions of the Thirty-third Annual Meeting 

of the Ohio State Medical Society, pp. 228. 
Transactions of the Medical Society of the State 

of West Virginia, pp. 120. 
Proceedings of the Fifth Annual Meeting of the 

Oregon State Medical Society, pp. 87. 

Of the papers in the Ohio State Society Keport 
we would mention that by the retiring president, 
Dr. W. H. Phillips, on The Testimony of Medical 
Experts. It is an able historical review of the 
question. Other contributions are by Dr. J. W. 
Hamilton, on Maxillary and Naso-pharyngeal 
Tumors ; Throat and Nasal Affections in their re- 
lation to diseases of the ear, by Dr. J. H. Buck- 
ner ; Subsulphate of Iron as a local remedy, by 
Dr. C. S. Muscroft ; the Curette in Uterine Dis- 
ease, by Dr. T. A. Reamy ; Chronic Inversion of 
the Uterus, by Dr. R. L. Sweney ; Quinine as a 
Prophylactic in Scarlet Fever, by Dr. C. H. Eeed ; 
and several reports of progress. 

At the West Virginia Society meeting, the 
President's address was by Dr. J. W. McSherry. 
Dr. M. S. Hall has a well-written report on State 
Medicine. Puerperal Insanity is discussed by Dr. 
A. H. Kunst. Lister's Antiseptic Method is ex- 
plained by Dr. W. H. Sharps. A partial report 
on Local Medical Botany is added by Dr. H. M. 
Gamble. A number of surgical cases are reported 



by Dr. John Frissel. Dr. J. Q. Hupp illustrates 
the diagnostic weight of certain symptoms ; and 
Insanity in West Virginia, is the theme of a paper 
by Dr. T. B Camden. 

The President's Address in the Ohio volume, is 
by Dr. L. L. Rowland. Dr. F. A. Bailey con- 
tributes articles on Fracture of the Radius and 
Ulna, and on Diphtheria ; Dr. J. A. Richardson 
on Septicaemia and Inverted Uterus ; Dr. D. B. 
Rice on the Duality of Typhoid and Typhus. Re- 
ports of committees, and the minutes of the pro- 
ceedings, occupy the remainder of the volume. 

Les Tumeurs Adenoides du Pharynx Nasal, leur 
Influence sur 1' Audition, la Respiration et la 
Phonation, leur Traitement. Par le Dr. B. 
Loewenberg. Paris, Delahaye et cie, 1879. pp.78. 
The author has had the opportunity to make a 
study of a considerable number of cases of poly- 
poid, adenoid and similar benign growths of the 
post-nasal regions, and discovered that they led to 
quite a variety of disorders of speech, hearing and 
breathing, which are not attributed to them in the 
current text books, and hence are likely to be 
misunderstood and erroneously treated. He, there- 
fore, very properly collected his observations, and 
now publishes them in the form of a monograph. 

The careful examination of the literature of the 
subject which he has made enables him to present 
it both historically, and from original investiga- 
tions. A number of cases are detailed, and his 
plan of treatment fully set forth. A peculiarly- 
shaped cutting forceps which he employs to de- 
tach the growths is figured in the book, and could 
readily be reproduced. The monograph is in all 
respects a very satisfactory one. 

Transactions of the Medical Society of the State 
of Pennsylvania, May, 1878. pp. 511. 
About one-third of the counties in the State are 
represented by reports to the State Society in this 
volume. Several are absent which have hitherto 
quite regularly appeared. Those which appear 
occupy about 150 pages of the 500, and over, 
contained in the volume, and of this 150 the two 
cities of Philadelphia and Pittsburg come in for 
nearly 50 pages. This, we fear, indicates that the 
" country members " need stirring up to the duties 
of maintaining more active relations to the State 
Society. 

There are, however, an unusually valuable series 
of essays and reports in the volume, of which, it 
will be remembered, we took notes in our report of 
the Transactions last May. They give the book a 
permanent standing which will make it prized by 
all readers. 



i6 



Editorial. 



[Vol >1. 



THE 



Plebifal Hub Surgkal lleporter, 

A WEEKLY JOUENAL, 

Issued every Saturday. 



D. G. BRINTON, m.d., Editor. 

The terms of subscription to the serial publi- 
cations of this office are as follows, payable in 
advance: — 

Blea. find Surg. Beporter (weekly), a ye«r, $6.00 
Half-Yearly Compendium of Med. Scie&oe, 2 JO 
Reporter and Gompendinm, - - - 7.00 
Puysician's Daily Pocket Becord, - • 1.50 
Reporter and Pocket Beoord, ... 6.25 
Reporter, Comp. and Pocket Becord, - • 8.25 

For advertising terms address the office. 
Marriages^ Deaths, and Personals are inserted 
free of charge. 

All letters should be addressed, and all checks 
and postal orders drawn to order of 
D. G. Brinton, M.D., 

115 South Seventh Street, 

Philadelphia, Pa. 

THE NEW YEAR AND ITS DUTIES. 

With this opening number of the new year we 
convey to our readers the good wishes which an 
honored custom suggests at the season. The 
probabilities are that it will be a year of large 
importance in the development of that highest 
branch of our science, preventive medicine. 
The terrible penalty which a wide portion of our 
country has suffered, from a lack of united and 
general effort to guard against preventable disease, 
will certainly not go unheeded. 

As it is a traditional and excellent custom to 
commence the year with a series of good resolu- 
tions, let the professional men of this land com- 
mence 1879 with the determination that, singly 
and collectively, they will do their utmost to 
establish in every State a Board of Health, and 
place it in competent hands, with money enough 
to carry out its plans; and that they will also 
unite in insisting on a national body of a like 
character. This we note as one of the agenda for 
1879. 



Another one should be an increased unification 
of the efforts and interests of the profession itself. 
In such a wide country as ours it is impossible for 
geographically distant members of the profession 
to hold frequent personal intercourse. But it is 
very possible, and much to be desired, that 
through county. State and national organizations 
the sense of belonging to one and the same pro- 
fession, to one free guild, as it were, be fostered 
and expanded. Only in this way can the influence 
of the profession, vast as it is in the aggregate, be 
sufficiently concentrtited to bring about corre- 
spondingly great results. 

Yet another subject of general and public inter- 
est, which cannot be accomplished too soon, is the 
enactment by every State in the Union of a " medi-r 
cal law" which will protect the people against 
the raids of quacks, and the profession against 
the degradation in public estimation it suffers 
by the presumption of unscrupulous fellows of 
the ■ baser sort assuming the title *of Di)ctor of 
Medicine. A few States have such laws, but we 
regret to say that in most either the words of the 
acts are so loose that they fail of being efficient 
instruments for the purpose designed ; or else, as 
is certainly the case in two States we can name, 
the persons empowered to carry out their provi- 
sions are weak and partial. It were highly 
desirable that a nearly uniform bill be drawn 
and introduced into the legislatures of all the 
States. 

In addition to these public matters which de- 
mand the attention of all, we would urge upon 
our readers two other subjects which cannot but 
be regarded as duties of the professional man. 

One of these is, that he should read. We do 
not say read this book or that one, take this journal 
or that one. Let him take whatever journal is 
best suited to his wants and tastes, and buy such 
books as he thinks will supply most accurately 
the deficiencies of his knowledge. But let him 
not fall into that frequent and deplorable indolence 
which so often besets middle aged and elderly 
men, of given up his scientific reading and con- 
tenting himself with the newspaper and the 
novel. As surely as he does so he will retrograde, 



Jan 4, 1879.] 



Notes and Comments. 



17 



mentally and medically. The money laid out in 
books of sound learning is not lost and not spent ; 
it is invested at a rate of interest which is higher 
than the highest obtainable at usury. A physi- 
cian of this State who had studied German in his 
youth told us once, that during twenty years of 
practice he estimated that his knowledge of that 
tongue had availed him in money, annually, as 
much as the legal interest on ten thousand dollars. 
So it always is with knowledge. It is ever in 
demand. As the Persian proverb says, "A dressed 
stone is not left by the roadside." 

The second duty we hold to be the imparting of 
knowledge to others. It is the eminent and 
peculiar characteristic of the profession of medi- 
cine that it sanctions no trade secrets ; it endorses 
no private means of distancing competitors. It 
denies that what a man has gained is his own. 
With a sublime assumption based on a magnificent 
charity, it calmly claims for the good of the whole 
whatever new knowledge, whatever ripe fruit of 
toilsome experience, the individual has won. He 
should obey that mandate and respect that divine 
arrogance of the caUing he has chosen, and as 
opportunity offers, to his neighbor, to the societies 
of which he is a member, and to the civilized 
world through the medical press, he should dis- 
close his secrets and distribute his wealth, or what 
he takes for such. They will be weighed and 
measured in a balance that never mistakes, and he 
will have his reward in exact proportion to his 
merits. 



Notes and Comments. 

Is it Safe to Puncture in Hepatic Abscess ? 

This question has been debated in a lively man- 
ner among physicians in this country during the 
last year, as we lately noted (see Eeporter, Nov. 
30, 1378). An important contribution to the subject 
is contained in the Lancet, November 16th, from 
Surgeon Major M. C. Turnell, senior physician of 
the General Hospital, Madras, and of course, of 
very wide experience in this disease. He gives a 
number of cases, and his opinion of the operation 
is thus expressed in an opening paragraph : — 

" In the following histories it will, I think, be 
seen that, even when none but the most ordinary 
precautions which any careful surgeon would take 



in opening an abscess in such an important region 
are adopted, the great bugbear — ' entrance of air ' 
— does not, as asserted by Surgeon-Major Lowe, 
and so feared by Dr. Budd, 'invariably' take 
place ; and the remaining cases show that if anti- 
septic precautions are taken, and, above all, any 
attempt at squeezing the abscess avoided, the 
simple incision by scalpel, followed by puncture 
with a trocar, is preferable to the forcible extrac- 
tion of pus by an aspirator ; and that keeping the 
wound open by a piece of carbolized lint is im- 
measurably superior to allowing the canula to 
remain in, as recommended by Dr. Murchison, 
and so frequently practiced by the older surgeons." 



Thymol and its Uses. 

As an antiseptic, thymol is much more powerful 
than either phenol orcresol (carbolic acid). Ranke 
uses a solution of one part thymol to one thousand 
parts water, instead of the carbolic solution of 
Lister. Dr. B. Kussner, of Halle, has tried it in- 
ternally. In doses of three to five drops of a one 
per cent, solution he found it useful in the diarrhoea 
of children. An inhalation of one part to one 
thousand of water reduced the fever and expec- 
toration in a phthisical case. 

Animals poisoned with thymol sink into a pro- 
found coma. After death their blood is dark and 
fluid. Fatty degeneration of internal organs is, 
however, not found. Injected into the veins it 
lowers the temperature and induces stupor. 



Sanitation on Shipboard. 

In a very well written and cogently argued 
paper, entitled "Air and Moisture on Shipboard, a 
Fragment of Applied Physiology," Dr. Th. J. 
Turner, Medical Inspector, u. s. N., attacks the 
insensate and excessive watering and washing of 
the decks of pur men-of-war. He summons 
numerous authorities to show that such a practice 
is useless for cleanliness, and harmful to health. 
He writes : — 

If this routine washing, holystoning, wiping, 
clamping, scrubbing, etc., is meant for cleanliness, 
an obvious inference therefrom would disrate the 
Augean stables from their billets as the pre- 
eminent examples of filth, and our vessels would 
be promoted to that unenvied rating. 

If it is not meant for cleanliness, then, in the 
light of modern scientific research, it is the ruth- 
less and barbarous wielding of a potent disease - 
producing weapon against the lives of the^ un- 
oflending and powerless. 

I trust to see the day when a holystone will be 
looked upon as a curiosity, and its temple, the 
sand-locker, vanish from off the face of the 



i8 



Notes and Comments. 



,rvoi. xi. 



deep. Then, with improved sanitary surround- 
ings will come an efficiency, from better health, 
and arising from these a discipline more consonant 
with enlightenment, than the semi-civilized code 
that now obtains. 

The Air of Stables. 

Among the absurd popular notions is that to the 
effect that the air of stables has some peculiarly 
salubrious properties. Probably this widespread 
notion arose from the recommendation of Dr. 
Read, more than a century ago (1767), to consump- 
tives, to go and live in cow stables. Generally 
speaking the atmosphere of a stable is as unhealthy 
as it is disagreeable to refined olfactories. The 
less there is of ammoniacal odor, and of the smell 
of urine, faeces and rotting litter, the more healthy 
are both the animals and their attendants. The 
best conducted stables are kept clean, and often 
sprinkled and washed with powerful disinfectants, 
and the animals they contain are much less liable 
to disease. 



Monobromide of Camphor as an Antidote to 
Strychnia. 

Professor Chirone, of Naples, has lately reviewed 
the uses of the monobromide of camphor. As a 
hypnotic he would not recommend it. In ovarian 
neuralgia and sexual erethism it is very satisfac- 
tory. But its most valuable use may prove to be 
its antidotal effect in strychnine poisoning, if we 
can believe Dr. Valentin Vino, who claims to have 
experimented with it on seventy-two dogs, and 
always succeeded in restoring them, even after 
violent convulsions had set in. It is fair to add 
that Professor ChiroAe does not vouch for this 
statement. 



Westphal's Diagnostic Point in Locomotor Ataxia. 

Professor Westphal about a year ago asserted 
that he had discovered a pathognomonic sign of 
sclerosis of the posterior columns. It is a very 
simple one. When in health, sitting with one 
knee across the other and the foot of the upper- 
most leg freely suspended, it is well known that a 
smart tap with a narrow instrument, such as a 
ruler, delivered on the tendon of the quadriceps, 
just below the patella, will cause the foot and 
lower leg to spring up with a jerk. Well, Dr. 
Westphal maintained that this jerk does not occur 
in posterior sclerosis, and that its absence is a 
sure sign of the presence of that formidable dis- 
ease. 

His conclusions were attacked by several ob- 
servers at the last meeting of the British Medical 
Association; and it seems pretty clear that his 



statement requires modification. No doubt the 
absence of this involuntary act is a significant sign 
of some important organic change. A new study 
of it has been made by Dr. S. Tschirjew in the 
Archiv filr Psychiatrie, and with great accuracy. 
The clinical result he reaches is that the absence 
of the reflex motion in man'points to degeneration 
of the posterior spinal roots and columns at the 
level of the third and fourth roots of the crural 
plexus ; but that in degeneration of the columns 
which does not reach so low as this the reflex 
phenomenon may appear. This very interesting 
result vindicates the symptom as of great import- 



Tayuya in Scrofulosis. 
The tincture of tayuya, our readers .will pro- 
bably remember (see the Eeporter, February 
26th, 1876), was introduced about three years ago 
as a remedy in syphilis, and appears to have been . 
well received, not only because it has some actual 
efficiency, but because it possesses the merit of 
having no smell and a rather pleasant flavor. 
Within a few months. Dr. Alpagonovello, an 
Italian physician, has reported a number of cases 
of scrofula with swollen or ulcerating glands, 
which recovered promptly under the administra- 
tion of ten-drop doses several times a day. His 
paper is in the Giornale di Scienze Mediche, No. ^ 
XXIX, 1878. 



Salicylic Acid Eruption. 

Among other unpleasant consequences of the 
Hse of salicylic acid in some constitutions, is an 
eruption of an urticarial character. Dr. F. Freu- 
denberg describes a case in the Berliner Med, 
Wochensehrift (No. 42, 1878), where the whole back 
of the patient was covered with ecchymotic patches, 
which extended to the sides and chest. The acid 
was discontinued, and the eruption slowly disap- 
peared, and was quite gone by the sixth day. The 
acid was then resumed, and again the eruption 
broke out, so that the medicin'e had to be defini- 
tively renounced. The patient was anaemic, 
which may explain the hemorrhagic appearance of 
the spots. 



Non-Oxydizable Iron. 

Prof. Barff has recently invented an iron that 
will not rust, if it is coated, externally, with mag- 
netic or black oxide. It is suggested that it will 
have many sanitary applications. For water- j)ipes 
the black iron will be invaluable, and also for 
water cisterns. For cooking it is quite equal to 
copper, and does not lead to the occasional danger 
of copper poisoning, which arises when copper 



Jan. 4, 1 879 J 



Correspondence. 



19 



utensils are employed. For making pickles it 
will be necessary, as it is the custom in large 
factories, to use vessels of platinum, the cost of 
which is enormous. Professor BariF's invention, 
however, will do away with this expensive neces- 
sity. Iron vessels of all kinds can be coated 
with magnetic oxide by this process. 

Human Parasites Derived from Eating Fish. 

Eecent investigations indicate that the great 
kidney worm {Strongylus gigas) lives in fishes in 
the young state, and the observations of Dr. Ber- 
tolus almost furnish proof that people contract the 
Swiss or broad tapeworm {Bothriocephalus latus) by 
feasting on imperfectly 'cooked trout. Indeed, all 
full-grown fishes sold in the shops as food are liable 
to contain entozoa ; but, with the exception above- 
mentioned, none contain parasites injurious to 
man. 

Correspondence. 

Treatment of Diphtheria. 
Ed. Med. and Surg. Reporter : — 

This disease has become as great a dread as 
smallpox. He who will make known a reliable 
remedy will be as immortal as Jenner. Scarcely 
a day passes but that some periodical publishes a 
sure cure. An Italian writer loses but one case in 
fifty-eight, by the use of phenic acid. A con- 
tributor to the Eepoeter says that liquor potassa 
answers the purpose, by destroying the exudation. 
Another uses sulphur as a parasiticide. Then 
comes the petroleum treatment. All these are in 
addition to* the orthodox remedies. In the face of 
all these there are epidemics whose fatality is 
appalling. 

My experience teaches this to be a zymotic 
disease, affecting the whole system. The treatment 
usually adopted is no better than no treatment. 
I have known families to pass through a severe 
form of this disease, without the attendance of 
any physician, as well as their neighbors who had 
professional aid. During the summer I was called 
to a family where several of the children were 
suffering from this complaint. The medicine left 
was found not taken on my return. They all 
recovered. These facts suggest the thought that 
perhaps we sometimes do harm in our efforts to 
cure. 

Previous to the past year the treatment I pur- 
sued was that of our modern text books, with a 
success as good as my neighbor's, which was far 
from satisfactory. In the Eeportee of October 
20th, 1877, page 310, appeared an article on this 
subject by Dr. Drysdale. The treatment he 
recommended was this : After moving the bowels 
with an appropriate cathartic, give a saturated 
solution of the chlorate of potassa, one tablespoon- 
ful every hour. Alimentation, of course. No 
gargling nor swabbing. Since then I have used 
this exclusively, adding quinine, iron and stimu- 
lants when demanded. My cases numbered seven- 



teen. One of these had been sick a week, and was 
dying when first seen. This really makes sixteen 
the number. All recovered save one, an infant of 
fifteen months. The type of the disease was not 
mild, judging from the experience of my cotempo- 
raries. 

My confidence in men and medicines is limited, 
yet in this treatment I have positive faith. It has 
won me fame and families. The membrane ex- 
tended into the larynx in two of my cases. The 
croup was alarming. Both recovered. There 
seemed to be no hope for the last one, a bright 
girl of fourteen summers. Here I used, as a last 
resort, the slacking lime remedy of the books. 
Her father, a man of intelligence, devised an 
apparatus, consisting of a coffee pot with a long 
tube made of the tops of seed onions. The lime 
in the pot, the water applied, the lid closed, the 
steam and lime particles were forced in a column 
direct to the throat, without danger of scalding. 
Relief followed each application promptly. 'The 
girl pleaded for its use. In twelve hours it began 
to melt, and was finally all expectorated as a 
creamy substance. J. J. Brown, m.d. 

Mifflinsville, Pa. 



Croup and Diphtheria. 
Ed. Med. and Sukg. Reporter : — 

In the December 7th number of your excellent 
journal is an article written by J. P. Farnsworth, 
M.D., of Clinton, Iowa, on these diseases. It is a 
very singular production, and is justly open to criti- 
cism. He fails to give us any sound pathological 
clew by which to arrive at a clear diagnosis. The 
symptoms must be very marked indeed, and the 
pathological appearance of the mucous membranes 
which receive the impress of these diseases must 
present very- dissimilar shades, to enable any phy- 
sician to instantly decide just which disease is 
present. In fact, the Doctor is willing to acknowl- 
edge that a similarity does exist; he says, "In 
diphtheria the membrane sometimes forms in the 
trachea, and the patient dies of suffocation; in 
croup this is always the manner of death." This 
admission virtually destroys the force of his argu- 
ments 

Both diseases are membranous, and while the 
membrane of croup generally confines its forma- 
tion to the trachea, yet it may and often does 
commence in the fauces, and travel down to the 
glottis, and through it down the trachea, extending 
to the minutest ramifications of the bronchial 
tubes. The same with diphtheria; it may com- 
mence in the trachea, and travel up, until it mani- 
fests itself over the whole mouth and nose, and 
being a plastic exudation, thrown out from a dis- 
eased membrane beneath it, it frequently spreads 
itself over the glottis, thus causing death by suffo- 
cation. Every intelligent physician knows this to 
be true, either from practical experience or from 
the writings obtained from the best minds of the 
profession. It is just this fact that has caused so 
much doubt and confusion relative to these diseases, 
and the Doctor vrould have conferred an inestim- 
able boon upon physicians and patients, had he, by 
sound pathological reasoning, clearly demonstrated 
this important problem. 

Diseases of the throat which assume a serious 
type have been rendered difficult of diagnosis, 



20 



N(^Wi and Miscellany. 



I Vol. 



from the hair-splitting distinctions made, which, 
in reality, will not admit of any difference. 
Happily, all diseases showing a membranous 
character are amenable to the same line of treat- 
ment, and the physician who will be guided by 
common sense and well known pathological laws 
cannot go far astray. 

In the case given us by the Doctor, why did he 
not perform tracheotomy, and thus give the child 
one of the main, in fact, the only chance for its 
life? He tells us that "there was no fever, no 
enlargement of the glands, no soreness, or even 
inflamed appearance of the throat," and withal 
seven years of age. This certainly was a case where 
tracheotomy was advisable, performed when the 
first sign of an excess of carbon in the blood was 
manifest. Statistics warrant the operation, and 
he had everything to make by performing it, while 
he had nothing to lose. Let the doctor try 
tracheotomy in his next fifty cases, and I am of 
the opinion that the results will give a showing 
that will be far different from the one he reports. 

Peoria, III. K. G. Allen, m.d. 



The Tlse of Tobacco. 
Ed. Med and Surg. Eeporter: — 

I notice in your editorial of December 7th, 1878, 
a statement of the enormous amount of tobacco 
used in this and other countries, followed by gen- 
eral remarks as to its "results," etc. 

It is a subject I have investigated closely, in 
this country and abroad ; and am satisfied that 
"the half" of the injurious effects of tobacco, 
direct and indirect, has not yet been told, even by 
those opposed to its use ; the physical depression, 
intellectual weakness and moral depravity it 
produces calling for and leading to nearly all 
other vices, and especially to intoxicating drinks. 
For, as to the last, I am confident that a vast 
majority of the drunkenness of this and other 
countries is the result, direct and indirect, of the 
physical, intellectual and moral degradation caused 
by tobacco, commenced in most cases years before 
the liquor. And this, doubtless, accounts, in the 
main, for the comparative failures of all temper- 
ance movements, thus far, the cause remaining 
comparatively untouched and operative. Many 
nominal temperance men, and I am ashamed to 
be compelled to admit, too many of them profes- 
sional men, lawyers, physicians, and even clergy- 
men, defiling the very air with their tobacco- 
poisoned breath, while lecturing on temperance. 

God forbid ! And I protest, in the name of 
decency and humanity, that no temperance lecturer, 
professional or other, should thus defile the air 
for decent cleanly people to breathe. And, further, 
from what I have witnessed of the injurious effects 
of tobacco chewing, snuffing, and smoking, I also 
protest against the propriety, or even the right, of 
professional men or teachers to use tobacco, on 
the ground of its filthiness, the bad example, and 
its disqualifying effects. Children do not want 
the poison from the breath or clothes of a teacher. 
The young lady or gentleman seeking spiritual 
advice or direction, should not be thus driven from 
the clergyman's study ; the client from the lawyer's 
office, or the patient from the physician's. Those 
who use it themselves might not object. But many, 
and especially ladies and the young, do not use it. 



and, therefore, have rights in this matter that 
should not be thus trifled with. 

Let these inexcusable nuisances be abated, and 
there may be some little hope that when the 
present generation of vile tobacco-worms in the 
" human form divine " shall have passed beyond 
the reach of thus contaminating, the physical, 
intellectual and moral powers of mankind may be 
allowed to assume their true dignity. And the 
masses, thus rid of such influences, will, it may be 
hoped, and reasonably expected, by leaving to- 
bacco alone, find no inducement or even inclina- 
tion, for the use of intoxicating drinks, or the 
practice of other kindred vices they noAV produce. 

E. R. MaxSON, a.m., M.D., LL.D. 

Syracuse, N. Y., Dec. ISth, 1878. 



News and Miscellany. 



Didactic Lectures on Dermatology at the Uni- . 
versity of Pennsylvania. 

The University has recently taken a new de- 
parture in the teaching of "dermatology. Pro- 
fessor Duhring is now delivering a course of 
didactic lectures on skin diseases to the advanced 
students. Although as yet no examinations are 
held in this branch, and the time (four to five on 
Saturday afternoons) is one which the average 
student is, or used to be, prone to take for recrea- 
tion, yet these lectures are very well attended. 
The earlier lectures have been occupied by the 
consideration of the subjects of anatomy, general 
symptomatology, etiology, pathology, diagnosis, 
treatment, prognosis and classification. The re- 
mainder of the course will be devoted to the 
consideration of the specific diseases. 

The exquisite wax models of diseases of the 
skin deposited in the University Museum by Dr. 
George B. Wood, as well as the large private 
collection of plates, water colors, photographs, etc., 
belonging to Professor Duhring, are employed in 
illustration, and the students of the University are 
to be congratulated on the opportunity now offered 
them of acquiring a knowledge of this practical 
branch of medicine. 



The Anthropological Section of the Paris Exhi- 
bition. 

This was organized under the charge of Prof. 
Broca, and was very instructive. There were no 
fewer than twenty-eight human skeletons, complete 
in all parts, exhibited; among these, five were 
those of Tasmanians, or the ancient inhabitants of 
Van Diemen's Land, whom the English have the 
credit of having exterminated from off the face of 
the globe ; the five men whose skeletons were here 
exhibited being, according to a French writer on 
the subject, the only individuals who left the island 
alive. 

The form and color of the hair constitute a char- 
acter of some importance in anthropology, and Dr. 
Topinard made this part of the human body, to- 
gether with the head, his special study. A very 
good collection of the hair of the different races, 
from the woolly and crisped hair of the Papous to 
the straight hair of the Chinese, was exhibited. 
The latter is well known to coiffeurs, as great 



Jan. 4, 1879 1 



News and Miscellany, 



21 



quantities are brought into requisition for ladies' 
head-dresses, the hair being dyed to suit their 
complexion or taste. 

The skeleton of a giant attracted great attention. 
It was that of a Spaniard, who, although aged only 
about twenty-four, stood two meters forty -five centi- 
meters, or about seven feet six inches and a half, 
and, as in all giants, the head was remarkably 
small in proportion to the size of the body. 

The sight of monkeys' skeletons and those of 
man, which were arranged side by side, excited 
the indignation of some fastidious people, and 
some religions journals condemned the arrange- 
ment as being immoral and an insult to humanity. 
Then those who had the arrangement of this part 
of the Exhibition must have insulted themselves ; 
but those who object to seeing man placed along- 
side of monkeys, as if to remind us of our origin, 
ought to remember that it is just by comparing 
one with the other that man stands out in bold 
relief, and notwithstanding some points of resem- 
blance, there are other predominant characters, 
even purely anatomical, which place man im- 
measurably above the monkey tribe. 



Organization of the German Medical Staff. 

This is as follofws : In the first place, to every mobi- 
lized German army corps there are attached three 
"sanitary detachments," each consisting of seven 
surgeons, one apothecary, sixteen hospital assist- 
ants, and a sick-bearer company provided with 
thirty stretchers, three carts, and six wagons fitted 
for the transport of severely wounded men. One 
of these three detachments is placed at the disposal 
of each of the two divisions of the army corps, and 
one is attached to the headquarters of the army corps, 
each detachment again being divisible into two 
independent sections, one of which may be de- 
tached for duty with each brigade of the division 
to which the sanitary detachment is told ofil Each 
mobile army corps is also accompanied by twelve 
field hospitals, which during an action are estab- 
lished immediately in rear of the troops engaged, 
and each of which affords accommodation for two 
hundred wounded. These are brought in the first 
instance by the sanitary detachments from the 
field of battle to the field hospitals, and there re- 
main and are tended until the arrival of the 
reserve hospitals, which are also attached to every 
mobile army corps. When the latter come up and 
take over the sick and wounded, the field hospitals 
at once move on again and rejoin their army corps, 
while arrangements are made for sending the 
wounded from the reserve hospitals of the corps to 
the seat of operations or to permanent hospitals in 
the. interior of their own country. 



A Carious Twin Monster. 

One of the sights at Paris this summer has been 
the curious monstrosity, Baptiste and Jacques 
Tocci. They were born October 4th, 1877, in 
Northern Italy. They are now strong children 
for their age, though neither have teeth. There 
are two heads, two necks, and two upper trunks 
absolutely distinct, so that in front and rear they 
seem like two individuals. About a line starting 
from the insertion of the diaphragm the single 
character commences, and in front it looks as if it 



were one individual, though behind there are 
indications of two dorsa. The anus is unique, and 
some of the observations in connection with it are 
singular, for, according to the evidence of the 
father, defecation takes place in each individual 
separately, noticed by the efforts of expulsion made 
by one of the upper heads without disturbing the 
other, so that there would seem to be two digestive 
tubes opening into a single rectum. 

Dr. Mosso found that the heart of Baptiste beat 
at the rate of 152 a minute ; that of Jacques 154. 
The most interesting part in connection with the m 
are the nervous functions. The cerebral and 
spinal centres are distinct, and there are three 
hypotheses as to the distribution of nervous power 
in the lower extremities. 

A reporter indulges in this speculation : — 
" If they reach puberty, as they only have one 
genetic organ, how will it supply the wants of a 
double intelligence?" The twins have escaped 
the perils of the first twelve months of infant life, 
and may probably live to puberty, for, according 
to the historian Buchanan, a somewhat similar 
creation lived to the age of twenty-eight years at 
the court of James iv. 



The Metrical System in Great Britain. 

It is a curious fact that the metrical system, 
which has been permissive in Great Britain, 
ceased to be so on the 1st of January, 1879, when 
the new Act relating to weights and measures went 
into force, after which date it is lawful to buy and 
sell only by imperial measures, among which those 
of the metrical system are not included. This 
seems a step backward. 



Items. 



— At Norwich, Conn., last week, two little 
children played at making ice cream with snow 
and milk, and flavored it with aconite instead of 
vanilla. The doctor gave them an antidote and 
ordered brandy, but under the no-license law the 
druggists dared not sell any liquor for any pur- 
pose. The spirit was finally procured and the 
children's lives saved. 

— Scarlet fever has appeared in the city almost 
as an epidemic. For the week ending Nov. 30th 
there were 100 cases reported. Since then the 
number each week has steadily increased, until 
now it has reached about 200 cases a week. The 
doctors are kept very busy. About three-fourths 
of the children attacked are saved. 

— News has been received that Dr. Skinner, 
Post Surgeon at Fort Peck, was hit on the head 
and mortally wounded while witnessing the killing 
of cattle for the Indians. 



Obituary Notes. 

— Dr. W. H. Earner, of Loraine, Ills., died 
December 14th, at the age of 65 years. When 
a young man. Dr. Earner went to Keokuk, and 
was for a time engaged in the government survey. 
Before the commencement of the rebellion, how- 
ever, he went south, and took up his residence in 



22 



News and Miscellany. 



[Vol. A 



Texas ; subsequently becoming a surgeon in the 
southern army. After the death of his mother he 
returned to Loraine, practicing medicine there and 
meeting with some success. 

— Dr. Charles W. E. Eauschenberg, of Atlanta, 
died November 7th, 1878, in his 56th year. He 
was a native of Germany, and a frequent con- 
tributor to medical literature, principally through 
the pages of the Atlanta Medical and Surgical 
Journal. ' 

— Alexander Marselis Vedder, m.d., a well- 
known physician of Schenectady, and ex-Mayor of 
that city, died December 20th. Dr. Vedder 
studied medicine, and received his diploma from 
the University of Pennsylvania in 1839. He 
served a short time as resident physician in Block- 
ley Hospital, and then began to practice in his 
native city. He was the first American physician 
to publish an article on Bright' s disease, and 
became noted as an authority in diseases of the 
chest. In 1840 he was appointed lecturer on 
Anatomy and Physiology in Union College ; 
shortly afterward professor. This position he 
filled for nearly twenty years. In 1856 he was 
elected Mayor of Schenectady. 

— Dr. Julius Millingen, who was a successful 
archaeologist and discoverer, and the physician 
who attended Lord Byron in his last illness, has 
just died at Constantinople. He was once in the 
service of the Sultan Mahmoud ii, and became 
physician to the Sultana, mother of Abdul Mejid. 

— Dr. George A. Kiecker, a graduate of Jeflferson 
College, Philadelphia, and some time surgeon to 
the Panama Railroad Company, died in Panama 
on the 4th ult., of congestion of the liver. 

— Dr. Joshua Y. Jones, who was a member of the 
State Senate many years ago, and who was also 
Lazaretto Physician once, died at his residence in 
Upper Dublin township, Montgomery county, on 
Christmas Day. 



QUERIES AND REPLIES. 

A correspondent asks whether it has been ob 
served thtt the drinking of hot or cold fluids when, 
or after, taking calomel, before it operates off, really 
has a tendency to produce salivation. 

Dr. W., Kansas.— T\iQ horse-hair snake is a fre- 
quent and harmless inhabitant of stagnant pools. 
You do not say, and we do not understand, the 
cause of the alarm it created in the family. 

Dr. JSldridge, of IlL—We shall, at an early date, 
give in the Repobtee a r6sum6 of the recent 
important discoveries on hog cholera and black 
quarter in cattle. All physicians, as you justly say, 
should be interested in them. 



MAEBIAGES. . 

Ei.KTNS— MuzzEY.— In Laconia, N. H., Nov. 26th, 
by Rev. h. Maivern, Dr. Daniel Elkins, of Lake Vil- 
lage, N. H., and Eva H. Muzzey, of Laconia. 

FiNLEY— Murray.— On the ^d of December, 1878, 
at St. Mary's Church, West Philadelphia, by the 
Rev. Dallas Tucker, assisted by Rev. Dr. Yarnall, 
Dr. I. A. Finley, U. S. Army, and Mary Elizabeth 
Murray, of this city. 

Gale— Wright.— In Oneonta, N. Y., October 9th. 
at the home of the bride, by Rev. J. T. Wright, of 
the North New York Conference, Dr. William 
Gale, of Westfield, N. J., and Hattie E., daughter of 
the ofBciating clergyman. 

HiMMEiiWRTGHT— TOLAND.— On the 11th inst., by 
Rev. James Hepburn Hargis, at the residence of the 
bride's father, in this city, Mary Toland and Francis 
E. Himmelwright, m.d. ' 

HoRTER— BiiUMNER.— On the 6th inst., at Ard- 
more, Pa., by Rev. W. H. Steck, J. Weiss Horter, 
M.D,, of Philadelphia, and Miss Jennette Mercler 
Blumner, of Ardmore. 

Miller— McGee.— At the residence of the bride's 
parents, in Cross Plains, Ind., November 28th, 1878, 

by the Rev. Edwards, Dr. Reuben Miller and 

Miss Lizzie McGee. 

Morgan— Lee.— In Cambridge, Vt., Nov. 2Sth, at 
the residence of the bride's father. Dr. J. B. Morgan, 
by Rev. George 8. Guernsey, George W. Lee, of 
Fletcher, and Jennie L. Morgan. 

Randolph — May. — On the 19th inpt., at the 
Church of the Holy Communion, by the Rev. Dr. 
Lawrence, ArWlur R. Randolph, of Eastcourt, Wilt- 
shire, England, late C*ptain Fifteeath (" The 
King's ") Hussars, and Edith Sybil, eldest daughter 
of Dr. J. Frederick May, of this city. 

Walker— Greer.— On November 6th, 1878, by 
Rev. A. H. Parker, Thomas P. Walker, m.d., of Dun- 
bar, Fayette county, Pa., and Miss Mary M. Greer, 
near Milroy, Mifflin county. Pa. 

Woolley— Walsh.— On Thursday, Dec. 19th, by 
the Rev. S. D. Alexander, d.d.. Dr. J. V. S. Woolley 
and Emma J. Wal^h, daughter of the late Andrew 
B. Brinckerhoff, all of JS e w York. 



DEATHS. 

Cooke.— In New York, on Tuesday, Dec. 17th, at 
his late residence, No. 29 West 2oth street, Chauncey 
S. Cooke, M.D., in the 71st year of his age. 

Gaylby.— In Philadelphia, suddenly, on the 20th 
instant, Annie M., wife of Dr. James F. Gayley. 

Jones.— At Three Tons. Montgomery Co., Pa., on 
December 25th, 1878, Joshua Y. Jones, m.d., aged 
seventy-two years. 

Krouse.— On Saturday, December 7th, at 6 a.m., of 
consumption. Dr. Julas Krouse, aged 30 yearw. 

Mills.— At Pittsfleld, Mass., Dec. 17th, Charles D. 
Mills, M.D., aged 51, son of the late Drake Mills, Esq., 
of this city. 

Payton.— At his residence. Church St., near Bergen 
avenue, Jersey City Heights, on Sabbath morning. 
Dr. Josiah Payton, aged 59 years and 6 months. 

Prewitt,— At Grand Junction, Tenn., Oct, , 

Dr. N. H. Prewitt, in the 47th year of his age, of yel- 
low fever. He was a highly esteemed member of the 
profession, and fell in the line of duty. 

Schell.— Saturday morning, Deeember 14th, at 6 
o'clock, George, only son of Dr. F. H. and Minnie 
Schell, aged 7 months. 

Silliman.— On the evening of the 26th inst., Catha- 
rine Elizabeth, wife of Dr. R. Silliman, u. S. A. 

Taylor.— In Wyoming, Jones county, Iowa, Nov. 
14th, Mrs. Isadora M., wife of Dr. E. S. Taylor, and 
daughter of Wm. H. Allbee, of Springfield, Vt., aged 
87 years and 6 months. 

Ward.— Suddenly, at Albany, N. Y., Dec, 19th, 
Willard Erskiue, aged 18 months, yuan -est child of 
Nina A. and Samuei B. Ward, m.d. 

Wilson.— At his residence, <n Billings. Christian 
Couuty, Mo., on the 28th of November, of pleurisy, 
in the 58th year of his age, Singleton Cameron Wil- 
son, M. o., youngest son of the late Rev. Joshua L. 
Wilson, D.D. 



iV^^^U^^^^ ( J>ba^<l^^^>^^^:t^e^ 



p^- 



WHOLE No. 1141.] 



JANUARY il, 1879. 



[VOL. XL, No, 2. "^"^ 



a?H: E 



MEDICAL AND SURGICAL 
REFOMTE 

EDITED BY D. G. BRINTON M.DS'^ *' 

■- % ^ 

Terms of Subscription,. FIVE I>OI.IiAKS per aminm, in adTauce.— Sin^^^opio/^n i&4"**« 

_ X ^^^ ^ 



O O IN TEIVTS 



ORIGINAL DEPARTMENT. 
COMMUNICATIONS. 

Vance, Reuben A.- The Fri ncip! es and Practice 
of Moiien Lu botrity , and the Recent Issues by . 
Which They are Iinperiltd 23 

Hamilton, y. M.— Reinaiks ou the Causes of 
CJuncealed Post- Pariuua Hemorrhage.... 28 

HOSPITAL REPORTS. 

Medical Department of the University of the 
City of New York.— Cliuu; for Diseases of the 

■ Nervous System, by i'rofessor William A. 
Ham niond.— Cerebral Congestion. 

Long Island C' lie^e Hospital, Biooklyn.— Acute 
Nephritis.— Caseous Pneumonia, or Q,uick Con- 
sumption..... 

EDITORIAL DEPARTMENT. 

PERISCOPE. 



30 



The Use of Chloroform in Labor 

The ourgical Treitmeut of Lupus 

Copaiba in Cirrhosis and Jaundice 

On Albuminf)us Substances in the Urine 

E'gotine in Acute Qphtlialmia 

Differences Betwetn Zymotic ai3d Septic roisons. 
Vomiting Alter Operationtj 



REVIEWS AND BOOK NOTICES. 



Notes on Current Medical Literature 

BOOK NOTICES. 

Difl'erential Diagnosis; A Manual qf the Com- 
parative Semeiology of the More Important 
l'i^eases(Hall) 

Beitrage Zur Entwickelungsgeschichte des Men- 
scheu, des Saugeihiers und des VogelscZeiiier). 



35 



Contributions to the History of the Develop- 
ment of Man, Mammals and Birds (Zeiller).... 36 

Transactions of the Minnesotat State Medical, 
society, I87S 37 

The Principles and Practice of Surgery (Ash- 
hurst) 37 

A Manual of Physical L'iagnosis (Delafieid and 
S tillmau) 37 

EDITORIAL. 

A Battle of the Giants over Evolution.... 38 



NOTES and comments. 

TheUseof the Actual Cautery... 39 

Mortality from Alcohol and Other Causes 40 

The Development of the Graafian Follicles 

During Pregnan c v ". 40 

The Physiological Action of Coffee 40 

The Treatment of Sprains 40 

Solubility of Chloral in Fatty Bodies 40 

The Pathology of Diphtheria 40 

CORRESPONDENCE, 

The Contagion of Yellow Fever (Bulloch) 41 

Pathology of Hysterical Cough (Dodd) 42 

Remarks on a Case of Puerperal Convulsions 

(Rawls) 42 

A Case of Scrofula (Hamer) 43 

A Case of Trephining (Kelly) 43 

NEWS AND MISCELLANY. 

New York Academy of Medicine 43 

Vital Stat istics of New York City in 1878 43 

Obituary Notes 44 

Statistics of Providence 44 

Resolutions of Respect 44 

Marriages and Deaths 44 



Established in 1853, by S. W. BUTLER, M. D. 



PHILADELPHIA: 
Published at No. 115 South Seventh Street. 




JAMES A. MOORE, Printer, 1222 and 1224 Sansom Street, Philadelphia. 



^ 



REMITTANCES RECEIVED.! 

"Week Ending January 4, 1879. 

N. B. — All Checks and P. 0. Orders must he drawn 
payable to the order of D. G. Brinton, M.d. 

^^&^ Subscribers are requested to inform us imme- 
diately if their remittances are not acknowledged in 
this column. 

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ada.— Dr. J. D. Kellock. Connecticut.— Brs. George 
B. Bouton, G. W. Edwards, E. B. Heady. District 
of Columbia.— Dv. D. W. Prentiss. Georgia.— T)rB. 
J. B. Smith, P. H. Wright. Illinois.— T>xs. J. A. 
Mead, H. C. Kibbie. E. Penwell, A. C. Brown, J. 
McCuilough, W. Walker, C. M. Dod?e, R N. 
Rickey, George Irvin. M. Reese, J. F. Harper, J. G. 
Ried, C. M. Easton, il. Mater, J. M. Janes, S. H. 
McOlung, D. H. Spickler, H. Holliday, L. M. 
Fooht, J. Schenck, ]S^. N. Vance, John Wright, 
T. D. Palmer. Kyner & Eakius. Indiana.— \}r^. 
R. O. Crandall, L. Mason, N. S. Winterrbwd, J.W. 
Marsee, J. F. Maddox, J. B. Lazerly, S. C. Max- 
well, E. W. King. Jowa.-Drs. T. C. McGee, E. M. 
Smith, J. W. Mitchell, B. G. Neal, H. Osborne, 
H. Z. Getz, M. G. Sloan, B. D. Townsend. Ken- 
iucki/.— Brs. D. Johnston. J. A. Lariabee, D. C. 
Tucker. Maine.— Brs. J. H. Robbins, H. Bacon. 
Maryland. —Brs.W: E. Wiegand, J. J. Turner, C.A. 
Fox, J. S. ChaglMn, I. M. H. Bateman. Massachu- 
setts.— Br?. W. J. Norfolk, R. B. Boynton, G. E. 
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Weem.S, M, M. Cook, Thom^is O'Reilly. New 
Hampshire.— Brs. G. S. Love, N. L. Folsom. Neiv 
Jersey —Bts. O, H. Shivers. W. P. iXIelcher, W. A.T. 
Keeler, Tomlinson. T. J. Kane, C. Newton, 

B. A. Watson, J. H. Griffith. New York— Brs. 
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Central News Company. • 



. I>R. GARRATT'S 

Constant Electric Disks, 

That any one can self-apply and wear, for 
the cure of local Weakness, congestion 
or pain, or for restoring: lost nerve 

power. They are noted for constant power 
[.to stop headaches and sciatica, to strength- 
en weak organs, lame back, or thorax, etc. 
While worn, by night or day, this silver- 
zinc Pad, or Belt, self-applies fine primary 
ga;i-vanism constantly, which cures nervous ills. 
" For the price and purpose it has no equal." So say 
physicians, druggists, and those now using this con- 
stant electric. 

Large Disk, 24 poles, $2.50. Disk Belt, with straps 
to go around the body, $3.50. Extra long, $5. Chil- 
dren's Disk, $1. Much less by the dozen. 

ELECTRIC ]>ISK & BELT CO., 

1135-m 5}i Hamilton Place, Boston, Mass. 




WYETH'S COMPRESSED TABLETS 

OF 

CHLORA TE OF P OTASH. 

For Hoarseness, Broncbial Irritation, Sore 
Tbroat, l>iphtlieria. Croup, etc., etc. 



Chlorate of Potash is a remedy of acknowledged 
value in cases of Diphtheritic Sore Throat, and in 
Inflammation of the Mouth and Throat, induced 
by a depressed state of the system. In these instan- 
ces, as..in the milder forms of Croup, it has, besides 
its depurative and detergent effects, a solvent action 
on the deposits, characteristic of those troublesome 
and dangerous affections. It relieves Hoarseness ; 
and in naanv cases of Fetid Breath from disordered 
secretions, it proves an efficient corrective. Its 
virtues in simple Angina, or ordinary Sore Throat, 
are recognized by many of the most eminent physi- 
cians. 

As the taste of this article is not disagreeable, we 
have prepared it in the form of Compressed Tablets, 
thus giving the patient the full benefit of its action, 
undiluted with Sugar, Gum, or other vehicles, which 
would not only prevent its effects, but which some- 
times themselves offend the stomach. 

The Lozenges usually contain about twenty-five 
25) grains of gum and sugar, with two grains of 
the Chlorate of Potash, while each of these Tablets 
contains simply five grains of the Chlorate, all of 
which, dissolved in the saliva, acts on the affected 
mucous membranes. 

If allowed to dissolve in the mouth, the topical 
effect is much more efficient than a saturated solu- 
tion, as, while the solution is but temporary, the 
tablet really acts as a continuous gargle. 



FOB SORE THROAT, HOARSENESS. 

DIREUTIONS :— Adults should take one every 
hour or two until relieved, allowing it to dis- 
solve slowly in the Mouth. Children half of one 
as often. 

For Offensive Breath, no remedy will give 
more certain relief ; use one, two or three times 
a day. 

For Diphtheria, Croup, and the more serious 
ailments, the physician should direct. 



PEPTOnriG PILLS, 



Pepsin, Pancreatiu witb I<acto-PIiospliate 
of Lime and Lactic Acid. 



(COPYRIGHT SECURED.) 
This pill will give immediate relief in many 
forms of Dyspepsia and Indigestion, and will prove 
of permanent benefit in all cases of enfeebled diges- 
tion, produced froiu want of proper secretion of the 
Gastric Juice. By supplementing the action of the 
stomach, and rendering the food capable of assimi- 
lation, they enable the organ to recover its healthy 
tone, and thus permanent relief is afforded. One 
great advantage of the mode of preparation of these 
pills is the absence of sugar, which is present in all 
the ordinary Pepsin and Pancreatic compounds. In 
this form, the dose is much smallei", more pleasant 
to take, and is less apt to oflend the already weak 
and irritable stomach. The results of their use have 
been so absolutely satisfactory, that we are confi- 
dent further trial will secure for them the cordial 
approval of the Medical Profession and the favor of- 
the general public. 

Each pill contains onegrain of pureTANCREATiN, 
which is equivalent to 10 grains of the ordinary or 
Saccharated usually prescribed and dispensed. Phj^- 
sicians will appreciate the great advantage of this 
mode of administration, the increased benefit to 
the dyspeptic being due to a full and effective dose 
of each, freed from unnecessary bulk, and really 
hurtful addition of sugar. A single pill will giV€ 
immediate relief. 

DIBBCTIONS :— Take one pill immediately 
after eating or when suffering from Indigestion, 
Lump in the Throat or Flatulence. For child- 
ren, reduce the pill to powder and give one- 
fourth or half, according to age. 

JOHN WYETH & BRO., 



llU-eow 



Cbemists, PHIL.ADEIiPHIA. 






THE 



MEDICAL AND SURGICAL REPORTER. 



No. 1141. • 



PHILADELPHIA, JAN. 11, 1879. 



[Vol. XL.— No. 2. 



Original Department. 



Communications. 

the principles and practice of 

modern lithotrity, and the 

recent issues by which 

they are imperiled. 

BY REUBEN A. VANCE, M.D., 

Of Gallipolis, Ohio. 

Read before the Tri-States Medical Society, at 
Springfield, Illinois, November 13th, 1878. 

"When a calculus remains for any time 
in the human bladder, that bladder be- 
comes diseased. This is true even in those 
cases in which the stone is due to a nephritic 
calculus formed in the kidney and deposited in 
the bladder, after a journey from the pelvis of 
the kidney to the vesical cavity. The irritation 
due to its presence causes congestion of the 
walls of the bladder ; hyperaemia of these 
tissues produces an augmented secretion of 
vesical mucus ; and the normally acid urine 
has its reaction changed by the presence of an 
excessive quantity of alkaline mucus. The 
series of changes thus inaugurated are familiar, 
I doubt not, to all my auditors. The urine 
decomposes, ammonia develops, and to the 
mechanical irritation due to the presence of 
stone an equally potent cause of congestion is 
to be found in the chemical irritants which 
result from the changes induced in certain of 
the constituents of the urine. The surgeon 
knows that in addition to those measures neces 
sary for the removal of the stone, others, look- 
ing to the control of the inflammatory action 
23 



which it has excited, must be adopted. In 
many cases palliative measures only are ad- 
missible, for the changes induced in the vesical 
walls are too extensive to be entirely overcome. 
Thus, when congestion has been attended by 
the development in the walls of the bladder of 
those results of inflammatory action which 
become organized, not only are those structures 
thickened and altered, but the cavity of tbe 
bladder is diminished in size. On the other 
hand, when the course pursued by these patho- 
logical phenomena has been different, and pro- 
longed retention of urine has been an element 
in the clinical history of the affection, atony, or 
even paralysis of the vesical walls, with dilata- 
tion of the cavity of the bladder, is to be 
expected. The extension of pathological phe- 
nomena along the ureters to the kidneys, or 
along the genital tract to the epididymes, 
explains why the kidneys and testes are impli- 
cated in cases in which the stone has remained 
in the bladder for a length of time. Con- 
gestion of the prostate and hypertrophy of the 
muscular tissues of the bladder are powerful 
agencies in producing enlargement of the 
former organ and the development of sacs in 
the walls of the latter. In addition to hyper- 
trophy of the prostate and sacculation of the 
bladder, the extension of inflammatory action 
from the cystitis due to vesical calculi, and 
consequent development of disease in the 
ureters, vasa deferentia, epididymes, testes and 
kidneys, the constant irritation of the bladder 
by the stone may stimulate into active growth 
any latent tendency to carcinomatous degenera- 
tion. Tumors of the bladder, though rare, are, 
nevertheless, occasional complications of vesical 



24 



Communications. 



[Vol. xl. 



calculi which are indirectly due to the presence 
of the latter. 

From the foregoing facts we learn why the 
surgeon is compelled to admit two elements into 
the problem which the removal of a vesical 
calculus presents to him — the one, the stone 
itself ; the other, the state of the bladder. A 
certain amount of preliminary treatment, di- 
rected to improving the condition of the bladder, 
is necessary, it matters not what measure is 
adopted for removing the stone. This is not so 
vitally important in lithotomy, as in lithotrity, 
yet it is required in both operations. For the 
success of lithotrity the irritability of the blad- 
der and urinary passages must be reduced to 
the minimum — this is one of the most important 
of the preliminary steps which the surgeon 
must take. Next, the general health of the 
patient must be improved to the maximum — 
tfhis measure is likewise essential. In fact, in 
the case of a patient with stone, in whom it 
would be reasonably safe — so far as the other 
bodily organs, aside from the bladder, are con- 
cerned — to perform any capital operation, no 
surgeon can properly decide against giving him 
the relief lithotrity affords until both these 
indications have been met. It may be inquired 
why these steps should be taken. A moment's 
glance at the contra-indications of lithotrity 
will render apparent the answer. In general 
terms, stricture of the urethra, hypertrophy of 
the prostate, atony, or paralysis of the bladder, 
sacculation, or carcinomatous degeneration of 
the vesical walls, villous tumor of the has fond, 
and renal disease, are the most serious obstacles 
to liihotrity. If to this list we add multiple 
calculi, and calculi too large or too hard to be 
crushed, we embrace all the special contra indi- 
cations to this operation. Judicious measures 
can often increase the calibre of the urethra, 
reduce 8\velling of the prostate, and restore 
power to the contractile walls of the bladder. 
In a paper presented to the Ohio Valley Medical 
Association, in 1876, 1 summarized my views on 
these points in the following language : — 

" If we revert to the essentials for lithotrity, 
it will be found that the crushing process is 
preferable in all cases where the stone will 
yield to the lithotrite, provided it is desirable 
to operate at all, and the urinary passages are 
large enough to admit the instrument with 
. ease, and not so • delicate but what it can 
remain in the bladder for a few moments at a 
time, and consider each one in detail, we will 



find, I think, that all the contra-indications to 
lithotrity can be arranged under one or other 
of these different heads. 

'' Is it desirable to operate at all ? To this 
question a negative answer must be returned 
in many, very many, cases. Patients who 
suffer from advanced Bright's disease, aneurism 
of one or other of the great vessels, organic 
disease of the heart, and the like, are mani- 
festly not subjects for lithotrity or any other 
capital operation. A microseopical examina- 
tion of the urine should be made sufficiently 
often to convince the operator not only that he 
is not dealing with a case of incurable kidney 
disease, but that the patient before him is free 
from organic degeneration of the bladder ; for 
experience shows that villous disease of that 
organ may, and not infrequently does, coexist 
with vesical calculus. 

" The size of the urethra and the degree of 
irritability of the urinary passages are very 
important elements in the question of lithotrity 
or lithotomy. The smaller size and greater 
degree of irritability in the genito-urinary 
passages of a child renders the crushing opera- 
tion less applicable than a resort to the knife. 
With advancing years this necessity for the 
employment of the knife grows less and less, 
until in many cases, in which the patients are 
still under puberty, the choice between the two 
operations will depend either solely, or to a 
very great extent, upon the ability of the 
surgeon to overcome vesical and urethral irri- 
tability to such a degree that the lithotrite can 
be tolerated in the bladder for a number of 
minutes in succession. It is sufficient, at pre- 
sent, to say that a judicious surgeon can over- 
come this hyperaesthetic state of the urinary 
mucous membrane in all cases where the pas- 
sages are of a size to allow the entrance of a 
lithotrite, and it thus becomes evident that in 
the hands of such • an operator the number of 
cases in which it will be possible to substitute 
the crushing for the cutting process will be 
much greater than in the hands of one who 
blindly follows the rule rather than strives to 
overcome contra-indications. The amount of 
obstruction afforded by a stricture of the 
urethra or an enlargement of the prostate 
gland, whether occurring alone or complicated 
by urinary fistulse and chronic cystitis, can 
only be estimated in each individual case. En- 
largement of the prostate can militate against 
crushing in those cases only in which the ob- 



Jan. II, 1879.J 



Communications, 



25 



struction is p;reat enough to interfere with 
the proper manipulation of the lithotrite. The 
chronic cystitis accompanying both stricture 
and prostatic hypertrophy, especially when 
attended by atony of the vesical walls, cannot 
be viewed as an evil in every sense of the 
word, for the fact that this condition of the 
walls of the bladder is accompanied by great 
tolerance on the part of the mucous membrane 
lining that organ — a degree of tolerance which 
makes that structure indisposed to take on 
inflammatory action when subjected to irritation 
arising from the presence of fragments of stone 
— prevents our including inflammation of the 
bladder among the conditions absolutely con- 
toa-indieating lithotrity. 

" In cases where the general bodily health is 
such as to admit of an operation, and the state 
of the urinary organs favors lithotrity, a crush- 
ing operation may be rendered impracticable 
by the size or the composition of the stone. 
Thus, when the calculus is of oxalate of lime, 
and exceeds an inch in diameter, it may be 
mechanically impossible to crush it by any 
force that can be brought to bear upon it by the 
lithotrite. In a very large uric acid stone, or a 
stone composed in great part of phosphatic salts, 
although within the power of an instrument to 
crush, yet the number of sittings necessary, and 
the length of time during which the fragments 
would necessarily be in immediate contact with 
the lining membrane of the bladder, are circum- 
stances which often induce the surgeon to resort 
to the knife, rather than to the lithotrite." 

To recapitulate in few words: Vesical cal- 
culus occurs in men and women, in the adult 
and the infant, at one time complicating fatal 
disease, at another constituting the sole com- 
plaint under which the patient labors, and 
while the measures adopted for the relief of the 
patient must vary with the special circum- 
stances of the individual case, yet no one should 
be subjected to lithotomy unless lithotrity is 
contra- indicated by one or other of the above 
named reasons. Good surgery and the dictates 
of humanity pronounce in favor of the painless 
and safe procedure by which the stone is 
crushed, and reserve for peculiar and excep 
tional cases the less tedious, and more brilliant 
operation by which the bladder is cut open and 
the stone removed at a single sitting, as in 
lithotomy. 

The London Lancet^ of March 16th, 1878, 
contains an account of the discussion at the 



Medico-Chirurgical Society of tha<- city, which . 
followed the reading of Sir Henry Thompson's 
paper presenting " An Analysis of Five Hundred 
Cases of Stone in the Male Adult." Sir James 
Paget stated that were he to recommence an ac- 
tive surgical practice he would begin with litho- 
tomy, and reserve for lithotrity only those few 
cases in which the calculus could be got rid of 
in two or three sittings. Sir James further an- 
nounced that he regarded lithotrity as hardly 
susceptible of additional improvement, and yet 
its results were often incomplete and unsatis- 
factory. Even Sir Henry Thompson seemed to 
sympathize with this feeling, and stated that in 
his last hundred cases he had been drawing the 
line more closely, and reverting to lithotomy in 
a larger proportion of cases. With such state- 
ments to guide him, it is not surprising that Dr. 
Van Buren concludes that *' the general tone of 
the discussion was not very favorable to litho- 
trity," especially when Sir Henry Thompson, 
in his final summing up, plead for an extension 
of the line so as to include cases "where the 
stone might be crushed at three, or at most, 
four sittings," beyond which point " he should 
mostly prefer to cut." 

No new objections to the operation are urged 
as grounds for these views. On the contrary, 
the strongest points made against lithotrity 
were on account of the cystitis "due to the 
injury done to the mucous membrane by sharp 
fragments of stone, and by continued instrumen - 
tation ;" the atony liable to be developed by it 
in old people, with a continuation of vesical 
irritability and phosphatic deposits ; and the 
liability to overlook minute fragments, and the 
conspquent unsatisfactory results. 

With this necessarily brief and imperfect out- 
line of the principles upon which is baaed the 
modern practice of lithotrity, considered in con- 
nection with the utterances and conclusions of 
eminent surgeons whose views have just been 
reported, am I not right in announcing that 
the new issues thus raised are calculated to do 
injustice to, and even imperil, lithotrity, the 
great triumph of conservative surgery ? Must 
the body of the profession, the world over, be 
bound by the conclusions to be derived from 
the practice of a few illustrious English sur- 
geons ? May not London specialists enjoy a 
practice which is not truly representative, and 
must the profession resign itself to the state- 
ment that lithotrity is only applicable to the 
comparatively limited class of cases in whio 1 



26 



Communications. 



[Vol. xl, 



the calculus can be crushed " at three, or at 
most, four sittings ?" 

A few words as to the latter point : 

In the first place, notoriously bad cases — those 
occurring in wealthy men who can command 
every agency which will mitigate their suflFer- 
ings, and postpone to the last moment the 
necessity for an operation — constitute a certain 
proportion of the practice which, after traveling 
far and near, and consulting surgeon after sur- 
geon, finds its way to the eminent metropolitan 
specialist. These patients are able to command 
the services of a Thompson, or a Paget, of a 
Coulson, or a Cadge, and their wishes have un- 
told influence in determining the kind of opera- 
tion employed. It is among such men that the 
calculus is permitted to grow, until the suffer- 
ing it causes becomes unbearable ; then these 
patients naturally determine to be relieved by 
the least painful and least threatening of the 
two methods available for that purpose. Exclude 
such cases as these from among the patients 
with advanced bladder and kidney disease — in 
whom the stone is large, the urinary passages 
tender, and the system irritable and predisposed 
to febrile reaction whenever the genito-urinary 
organs are disturbed — upon whom eminent 
lithotritists ha/e operated, and I venture to say 
that there would be a decided diminution in the 
death rate of patients in whom numerous sit- 
tings would have been necessary had not the 
cases resulted fatally ! 

In the next place, extensive degeneration of 
the kidneys is far more common in England 
than in this country, and vastly more frequent 
oa the Atlantic seaboard of this continent than 
in the Mississippi Valley. Thus, even the local 
practice of Lmdon surgeons has an element 
which is adverse to the successful treatment of 
just that class of cases with stone which require 
numerous applications of the lithotrite for their 
relief. 

Other factors, which I have not time to dwell 
upon now, enter into and complicate the problem, 
but the foregoing illustrations will show that 
the exceptions which can be taken to conclu- 
sions founded upon the analysis of a special 
class of cases are such as cast doubt upon the 
weight and cogency of any argument based on 
such analysis. 

A justly distinguished New York Surgeon — 
Professor Wm. H. Van Buren, of the Bellevue 
Hospital Medical College — takes occasion to 
refer to this " new departure " in the operative 



surgery of the bladder foreshadowed by the 
paper of Thompson, and inaugurated by the 
discussion at the Medico-Chirurgical Society 
and in an article which he contributed to the 
Medical Record of September 28th, 1878, grants 
the validity of the objections made to the opera- 
tion, but doubts the necessity of recurring to 
lithotomy as the only remedy, and asks : Cannot 
lithotrity be rendered less imperfect ? To this 
question ho answers that " there is reason to 
believe that a discovery has been made by an 
American surgeon which may take away from 
lithotrity its chiefest objection, and it may 
prove that, as an operation, it is susceptible of 
improvement." Dr. Van Buren thinks that the 
evidence adduced by Professor Bigelow, of 
Harvard, goes far toward the demonstration of 
" a tolerance by the bladder of protracted 
manipulation, which has not been hitherto 
recognized,"* and publishes the details of cases 
which go to show the truth of the principles 
announced by the Boston surgeon. I am dis- 
posed to accord great value to this plan of re- 
moving the calculus, and believe that Bigelow's 
system — complete granulation of the stone at 
one sitting, with measures to evacua4ie the 
debris, the patient meanwhile being under the 
influence of an anaesthetic — will be the means 
of saving from the knife another section of the 
class of calculous patients now generally aban- 
doned to the lithotomist, although in doubt, I 
must confess, as to the novelty of some of Dr. 
Bigelow's propositions. Nothing but the im- 
perfection of the original apparatus prevented 
the first operation, performed in the presence of 
the representatives of the French Academy of 
Medicine — the Barons Chaussier and Percy — 
from being a case of " Lithotrity by a Single 
Operation." In that case the operation was 
continued, at intervals, for forty minutes. 
Eleven days subsequently it was repeated ; the 
third and last sitting was held at the end of an 
interval of ten days ; twenty days after the 
first operation the man was free from stone. 

Again, the Baron Heurteloup, on the 24th of 
July, 1829, operated on a patient, sixty-four 
years of age, at the house of Mr. White, a 
surgeon in London, and in fourteen minutes 
removed a stone fourteen lines in diameter. 
Nevertheless, Dr. Bigelow has done good service 
in calling attention to this property of the 

Bigelow— "Lithotrity by a Single Operation." 
American Journal of the Medical Sciences, January, 

1878. 



Jan II, 1879.] 



Communications, 



27 



bladder — for it seems that the inculcation of 
the salutary rule never to keep any instrument 
in the bladder lona^er than the conventional 
limit of from three to four minutes, has origi- 
nated an idea that the bladder is exceptionally 
intolerant of instrumentation — and while I be- 
lieve, as I have already stated, his method vrill 
save some patients from the alternative of the 
knife, I doubt if it can do much for that class 
in which, according to the rule announced in 
this paper, lithotrity is the measure to which 
they are entitled to look for relief. 

Dismissing Professor Bigelow's plan as inap- 
plicable in the vast majority of cases in which 
the stone should be crushed, let us review the 
steps calculated to render lithotrity a painless 
and successful operation. 

In the first place, the capabilities of the 
operation must be made the subject of earnest 
study. To dwell on this point as its importance 
merits would be to inflict on you a voluminous 
disquisition. 

Secondly, individual experience must be ac- 
cumulated. This point, also, will be dismissed 
for the same reason. There is one important 
fact to be borne in mind in this connection, and 
that is, other things being equal, the death rate 
in lithotrity will diminish in direct proportion 
to the experience of the operator. 

Thirdly, the preliminary treatment adopted 
materially modifies the fatality of the opera- 
tion. Two of the most important indications 
the surgeon must meet have already been recited. 
They are : 

[a.) To improve to the utmost the patient's 
general health ; and 

(5.) To reduce the co-existing inflammation 
of the genitourinary tract. 

A third measure of equal moment is — 

(c ) To determine accurately the patient's 
temperature, and to discover and record any 
variations from the normal standard. 

The lithotritist should have the temperature 
of his patient taken every six hours, or oftener. 
It is not enough that the family be supplied 
with an axillary thermometer, and that the 
unskilled efi'orts of inexperienced persons, be 
recorded for the surgeon's information. I con-' 
sider this measure of vital importance, and in 
insisting that a proper instrument be procured, 
and its application confided to professional 
hands, I am consulting the surgeon's interest 
almost as much as the patient's. Keep a regis- 
tered thermometer by the patient's bedside — pre- 



ferably one that' possesses an index which re- 
cords the elevation reached by the mercury — 
and at regular intervals have the bulb passed 
into the patient's rectum, and kept there from 
five to ten minutes at a time. If the surgeon 
visits his patient but twice a day, yet by using 
a self-recording thermometer he can have the 
temperature taken with mathematical accuracy 
four times in every twenty four hours. Thus, 
let him take the temperature himself at his 
morning visit, and after noting its height, return 
the index to its position, so that at the next 
appointed hour the patient can insert the ther- 
mometer without assistance. The lat.ter need 
do nothing more than return the instrument to 
its case after removing it from the bowel — the 
index will remain at the point where the heat 
of the body has raised it until the surgeon's 
evening visit, when he can note its degree, 
return the index to a point below the standard 
of health, and take the patient's temperature 
for the evening. The latter recorded, the in- 
strument once more arranged for use as at noon, 
is confided to safe hands, in order that the tem- 
perature may be taken at midnight. It very 
frequently happens that these temperature ob- 
servations reveal a daily elevation beyond the 
bounds of health — an exacerbation that dimin- 
ishes, and may even disappear with the adoption 
of measures designed to prepare the patient for 
the operation. In no event should the stone be 
crushed while the temperature curve deviates 
materially from a healthy standard ! 

Fourthly, the remedial measures which aid 
in subduing cystitis prior to crushing the stone 
may likewise prove of incalculable value in 
preventing the redevelopment in the bladder of 
inflammatory action, from the irritation caused 
by fragments of the calculus. 

There is one drug which renders the lithotrit- 
ist great and timely assistance : I refer to opium, 
preferably employed in the form of morphia, 
and administered hypodermically. By sus- 
pending the activity of the muscular walls, and 
diminishing the sensibility of the mucous 
lining of the bladder, this drug, in great degree, 
prevents the injury that otherwise would 
inevitably follow the violent contraction of the 
vesical tissues upon the sharp, angular frag- 
ments which result from the action of the litho- 
trite. What lithotritist whose experience has 
been at all extensive has not seen the wonder- 
ful change which a chill marking the onset of 
cystitis has initiated in a patient who, but a 



28 



Communications, 



I Vol. xl. 



few hours before, was doing so well? The 
torturing pain in perineum and bladder, the 
nervous anxiety and constant restlessness, but, 
above all, the sharp attacks of vesical spasm 
recurring every moment or two, in which blood 
and pus, mingled with urine, are forcibly 
expelled from the urethra, mark the imminence 
of the bladder's peril, and constitute a clinical 
picture not readily forgotten. The surgeon is 
seldom placed in a situation demanding greater 
promptitude and skill ; but rarely are his efforts 
80 potent for good or for evil. The bladder 
must be quieted, at all hazards. If a fragment 
has become impacted in the urethra it must be 
removed ; and if, despite all efforts, the bladder 
cannot otherwise be brought under control, 
lithotomy must be performed, the fragments of 
stone removed, and the patient thus given a 
chance for his life. But the latter alternative 
need rarely be embraced, thanks to the efficacy 
of remedial agents, especially morphia, admiais- 
tered hypodermically. The instant any evi- 
dence of cystitis develops inject a large por- 
tion of morphia, the size of the dose being 
determined by the patient's susceptibility, as 
learned by absolute test during the preliminary 
treatment, and not judged of by conventional 
rules, and in the vast majority of cases the 
patient will be instantly relieved from pain, 
and the free perspiration then developed will 
mark the subsidence of all threatening symp- 
toms. 

Finally, the lithotritist can rely with confi- 
dence on the indications afforded by the ther- 
mometer relative to many important details 
pertaining to the operation. 

Armed with a knowledge of the patient's 
susceptibility to the action of opium, and pos- 
sessed of the temperature observations which 
show how nearly the latter's heat curve ap- 
proximates that of health, the surgeon has data 
which not only enable him to recognize the first 
abnormal sign, but furnish him the means of 
counteracting or controlling it. The information 
thus obtained is a guide to the number, the 
duration and the frequency of the sittings. To 
the question. How are we to treat the cystitis 
which so frequently occurs after first crush- 
ings, and which is regarded by leading British 
lithotritists as " so serious adefect " in lithotrity ? 
I will answer by saying that by the adoption of 
the measures advocated in this paper vesical 
inflammation can, in many cases, be prevented ; 
in others, its severity will be mitigated ; and in 



all instances its earliest approaches will be 
recognized, and its progress combated with all 
the resources at the surgeon's command ! 



KEMAEKS ON THE CAUSES OF CON- 
CEALED POST-PAETUM HEM- 
OEEHAGE. 

BY S. M. HAMILTON, M.D., 
Of Monmouth, 111. 

Case 1. — Was called to attend Mrs. A., aged 
twenty-three, in her first confinement, at full term. 
There was nothing unusual, save that the pain, 
from the first, was very severe. The agony during 
the contractions was extreme, with but little rest 
between. The entire labor lasted about five hours, 
and at its conclusion there was no more than the 
ordinary amount of blood lost. The abdominal 
bandage was applied, as usual, over a well con- 
tracted uterus, and all seemed in excellent con- 
dition. In about thirty minutes the usual symp- 
toms of concealed uterine hemorrhage came on — 
namely, ashy paleness of the face, sunken features, 
cold skin, no pulse at the wrist, and a symptom 
which is quite pathognomonic of this affection, a 
constant turning of the head from side to side upon 
the pillow. 

On examination I found the uterus firmly con- 
tracted and no larger than before. In two or three 
minutes, however, the contraction gave way, the 
uterine tumor gradually disappeared from the 
grasp of the hand over the abdomen. As is the 
custom, I " turned out the clots," amounting to 
very little as to quantity, having given, in the 
meantime, ergot, ipecac, and brandy in pretty 
fall doses. The uterus then contracted to its 
proper size and consistence, the pulse returned at 
the wrist, the capillary circulation was re-estab- 
lished, and all seemed well for the time. At inter- 
vals of about half an hour the symptoms returned, 
just as detailed above, two or three times, when 
they finally disappeared, and the patient made a 
rather slow but good recovery. In no instance did 
the uterine contraction disappear until the other 
symptoms were fully established, and in no instance 
was there more than one or one and a half ounces 
of blood lost. 

Case 2. — Attended Mrs. B., aged forty-six 
years, in her fifth confinement, on the 8th day of 
July. The labor was concluded in about two 
hours, and was in every way easy and natural. 
She made a good recovery, requiring no treatment 
whatever. On the sixth day of August, one month 
after the birth of her child, I was called in great 
haste, and found her in a complete state of col- 
lapse. Cold skin, flooded with perspiration. No 



Jan. 1 1, 1879- 



Communications . 



29 



puLse at the wrist. Continual tossing of the head 
from side to side ; eyes closed. Face ashy pale ; 
lips white, and the patient in constant dread of 
impending death. Intellection not at all affected. 
The attack came on rapidly. She had been in 
her usual health, except that for the last three or 
four days she had some dyspeptic symptoms, one 
of which was distention and a feeling of uneasiness 
after eating, in the region of the stomach. She was 
thin of flesh, as was usual with her during lacta- 
tion. Her child is a model of robust health. She 
had eaten nothing that day, and some efforts at 
vomiting produced nothing but a little colorless 
mucus. She has had no exhausting discharges of 
any kind. Bowels regular; urine normal in 
quantity and quality ; uterus healthy. ' 

She complains of a deadly sensation of sinking 
at the pit of the stomach, and constant whirling of 
the head (as she calls it). 

Under the free use of brandy and stimulating 
frictions she rallied for a few hours, but relapsed 
into the same condition as profoundly as before. 
Kecognizing, as no one could fail to recognize, the 
strong resemblance between this and the ordinary 
cases of so-called concealed uterine hemorrhage, 
I gave her pretty large doses of ipecac, which 
first stopped the vomiting, and afterward induced 
a nausea of a different character, apparently, for 
with it all the alarming symptoms subsided. 
There were relapses of more, or less severity for 
seven or eight days, which the ipecac, never failed 
to control. After the subsidence of the' first 
attack it was never again necessary to give the 
drug in such doses as to produce nausea and vomit- 
ing. In the meantime the patient was given 
tonics and suitable food, and about the eighth day 
she was discharged, and is in good health up to 
this time, a period of one year and three months. 

These two cases will, of course, be recognized by 
every physician, as belonging to a type of disease 
very often met with in practice. They are intro- 
duced as the basis of a few remarks as to their 
pathology. 

The universally received explanation of the con- 
dition present in Case No. 1 is, that the frightful 
train of symptoms is produced by loss of blood. 
But they are strikingly unlike those produced by 
hemorrhage from other causes and other localities. 
And who has not been struck by the surprising 
and unaccountable disproportion between the loss 
of blood and the effect produced upon the patient 
in very many of these cases ? In all where I have 
had opportunity to observe them from the first, 
the failure of uterine contraction and the concealed 
hemorrhage followed the attack and did not pre- 
cede it. Does it not follow, then, that the col- 



lapse. of the uterus and the consequent hemorrhage 
is merely one of the manifestations of a diseased 
condition somewhere else? In Case No. 2 we 
have all the conditions usually present in post- 
partum hemorrhage, except the hemorrhage. The 
treatment in both cases was essentially the same? 
with a like result in each. 

To "turn out the clots" may not always be a 
useless operation, but that it is based upon a false 
pathology, is very probable, at least. 

No doubt these cases, or most of them, have 
their origin in some temporary derangement of 
the ganglionic system of nerves. And that there 
is present an atonic condition of the nerve fibre, 
which may be brought about by a great variety of 
causes. It is not confined by any means to females. 
Several perfectly well marked cases in males have 
fallen under my own observation. 

Nausea and vomiting has always been con- 
sidered, and it really is, in most cases of tedious 
labor, a favorable indication. Not because it pro- 
duces relaxation of the parts undergoing dilata- 
tion (as some suppose), but because the act itself, 
a purely nervous one, indicates that the proper 
coordination between the nerve centre and the 
muscular fibre to be moved has been reestablished. 

The function of the great sympathetic system 
is probably not understood in its entirety by any 
one. That it has much to do with circulation, 
enervation, digestion and assimilation, is plain. 
That it presides over the contractility of the un- 
striped muscular fibre, wherever found, is pretty 
clearly demonstrated. It is fair to presume that 
serious disturbances to the organism would result 
from even a temporary loss of function in so import- 
ant a part of the human anatomy. The collapse in 
cholera and cholera morbus can hardly be ac- 
counted for in any other way, and "concealed 
hemorrhage," so called, is but another manifesta- 
tion of the same diseased condition. The action 
of ergot and ipecac is perfectly consistent- with 
this view. They both act upon the unstriped 
muscular fibre by their reflex stimulating effect 
upon the great ganglionic nerve centres. The 
hemorrhage is not always an unimportant factor in 
these cases. It is always right to control it by all 
appliances at the disposal of the attending physi- 
cian, but he who looks no further than the col- 
lapsed wall of the uterus for the real cause of the 
difiiculty in this most serious ailment takes a very 
short-sighted and false view of the subject. 



— The Commission appointed by the last Con- 
gress to report on the nature, causes and preven- 
tion of hog cholera have their report ready, and 
it will appear soon. 



30 



Hospital Reports, 



[Vol. xl. 



Hospital Reports. 



MEDICAL DEPARTMENT OF THE UNI- 
VERSITY OF THE CITY OF NEW 
YORK. 

CLINIC FOR DISEASES OF THE NERVOUS 
SYSTEM, 

BY PROFESSOR WILLIAM A. HAMMOND. 

Reported by Worthington Myers, a.m m.d. 
Cerebral Congestion. 

{Omtinued from Vol. xxxlx,p. 537.) 

Gentlemen : — At last lecture I finished the 
symptoms of cerebral congestion. In the passive 
form they are not so dangerous. In the soporific 
form the symptoms are more intense. It may be 
said, in general terms, whatever may tend to aug- 
ment the flow of blood to the head produce^ active 
congestion, but if retarded, the passive form. For 
instance, emotion, sorrow, intellectual effort, etc., 
increases the flow of blood to the head. Every time 
a person faints, every time he utters a sound, 
every time he tastes, the amount of blood to the 
brain is increased. Emotional disturbance of a 
sorrowful character tends to produce it. Some at- 
tribute it to heart disease, and but few to its real 
cause, congestion. When the Roman mothers 
heard of the death of their sons at the battle of 
Cannse, the revulsion of feeling was so great that 
they were struck dead. Another cause is the ex- 
citement produced in giving evidence on the 
witness stand. People often make the remark, 
" if it is not so, may I be struck dead." When this 
occurs the masses suj^pose it was a visitation of 
providence. Stooping down, pulling on the boots, 
straining at stool, efibrts in labor, all tend to 
produce it. 

The passive form is induced by anything wh'ch 
prevents the return of blood to the brain. Tumors in 
the neck, tight collars, etc. Cases of cerebral con- 
gestion were quite frequent in the United States 
Army, owing to the regulation stock at one time 
worn. Hearty meals at night tend to produce it, 
by pressing upon the abdominal veins, which tends 
to impede the return of the blood. 

The number of post-mortem examinations not 
very large. In the first place, the convolutions 
are flattened by serum effused, and instead of 
being rotund, are of a flattened form. The veins 
and arteries are enlarged and tortuous. Upon 
cutting into the substance of the brain, you will 
find the small red spots called the puncta vascu- 
losse. Now, when congested they are found in 
large numbers through the whole white substance, 
of a pinkish hue, and the tissue softened. And 
again, you will find what is very properly named 
the cribriform stage. . The blood vessels of the 
brain not in contact with the brain substance, be- 
cause, between it and the substance of the brain is 
a canal, and in that canal the vessel runs. Now, 
the advantage of this arrangement is, the brain 
can undergo a considerable amount of congestion 
without morbid phenomena. If it were not for 
this wise provision a man could not think ; he 
would fall down in a stupor. Hence the advan- 



tage of this arrangement. Now, after death, these 
vessels shrink and leave holes, and when you see 
this it is the cribriform state, like a sieve, and you 
may know that the patient has suffered from cere- 
bral congestion. 

Now, as regards the pathological physiology, 
the excessive amount of brain work a patient 
undergoes increases the amount of blood to.th^ 
brain. They lose their elasticity, as a worn-out 
India rubber ball, or a bundle of leather. With 
congestion, therefore, they lose their elasticity. 
The fact that they do not sleep at night is a symp- 
' tom of congestion, viz., increase of flow of blood ; 
a man who does not sleep at night is consuming 
his brain ; he increases the amount of blood to the 
brain. The theory they act upon is that the 
amount of blood is not increased by pressure. The 
brain is enclos ^d in a skull, and does not admit of 
pressure. For instance, you stoop down and hold 
the head in a depend iut position ; the cerebro- 
spinal fluid rushes into the ventricle, you feel a 
sense of eff"aslon and mllness in the heal. The 
moment you rise up you feelJigliter, because this 
pressure is removed. The dizziness is owing to 
the fact that the fluid rushes out, and if this is so, 
the blood can do the same thing. We have actual 
proof this is so. Several years ago I performed a 
number of experiments, and came to the conclu- 
sion that when a person did not sleep, the amount 
of blood to his brain was increased, and in order 
that he may sleep, the amount of blood must be 
lessened. 

The following case came under my observation. 
A man, standing on the platform of a car, was 
suddenly thrown off", the vertex of the head strik- 
ing the curb stone. He was taken up insensible, 
and remained under treatment six months. He 
was subject to epileptic convulsions. He had a 
cavity in his skull three inches wide and about six 
inches long. Greater portion of right parietal 
bone, part of frontal, occipital and temporal bones 
were involved. I observed that when he slept, 
the scalp over this fissure was depressed, when 
awake, something increased the pressure. Now 
nothing could do this except blood. This was in- 
creased and diminished. A work published pre- 
vious to this, by Mr, Durham, shows that he bored 
holes in the skulls of animals, and found that when 
they slept the pressure was diminished, but in- 
creased when awake, clearly demonstrating the 
fact that this increase is caused by the pressure of 
the blood. 

Subsequently Dr. Weir Mitchell, of Philadel- 
phia, and myself invented an instrument, neither 
of us knowing that the other had anything of the 
kind, which shows the theory clearly. This in- 
strument was unknown to either, but made simul- 
taneously. For example, we trephine a dog ; the 
rubber of the instrument merely touches the dura- 
mater lightly ; upon increased pressure the fluid 
rises in the tube ; when diminished, it falls ; when 
he sleeps, the fluid falls ; when awake, it rises in 
the tube ; while the relation which the blood bears 
to the symptoms is arterial and does not pass a 
certain change, he is excited, viz., the stage of ex- 
altation. He is passively exhilarated. A great 
many patients are in this state, the excited. Another 
element is brought to bear ; he is then depressed. 
Symptoms of paralysis, numbness, the blood ves- 
sels so large and distended they press upon the 



Jan. II, 1879.] 



Hospital Reports, 



31 



brain. In some yon have stupor, apoplexy, rup- 
ture and cerebral hemorrhage developed. 

The next point is in regard to the diagnosis. It 
may be confounded -with a great many diseases, 
viz. with Bright's Disease. Yon may have stupor 
and pain in head from the presence of urea in the 
blood, but to establish the fact you must have a full 
history of the case. Examine all possible contin- 
gencies Tvhich may come under your observation. 
If, upon examination, you discover albumen, you 
will be safe in pronouncing the case as one of 
Bright's Disease. Again, it is sometimes con-, 
founded with embolism, which is due to the sudden 
plugging up of a blood vessel in the brain. In 
such cases do not be in a hurry to determine your 
diagnosis. Ascertain the full history of the case. 
In cases of embolism examine the heart ; make 
inquiry if he has had rheumatism. In a large 
majority of cases, if congestion, the symptoms will 
gradually abate without much detriment. If embol-' 
ism, we will have as a sequela paralysis of right 
side ; if cerebral congestion, no particular side is 
chosen. There are some signs, however, which serve 
to form a correct conclusion in a great many cases, j 
For example, in cerebral hemorrhage, conscience ' 
is lost, congestion is lost, stertorous in hemorrhage, 
not so in congestion. You can form no definite 
conclusion when the symptoms only last a short 
time. The prognosis is not always unfavorable. 
The patient must use his brain in a favorable con- 
dition, which he will, if he follows advice and 
treatment. In all cases you should recollect that 
the first important step in the treatment is to re- 
duce the amount of blood in his brain. 

Case 1. — Here is a case which is very interest- 
ing. You will meet with them quite often, as a 
rule, therefore you must study them attentively, so 
that you may not fail to recognize them as they 
arise. Now, you see this woman ; she has a tremu- 
lous motion in her limbs ; can scarcely control 
this. I will ask her to carry her hand to her fiice. 
Observe, if you please, how it trembles ; passive, it 
remains quiet. This is an important fact. There 
is a disease in which the hand does not remain 
quiet in this way. I will ask her to walk ; all the 
muscles tremble. She first observed this tremu- 
lous motion after the death of her child, some few 
years ago ; caused from excessive emotion. She 
has paralysis of right side of face. She cannot 
close the right eye tightly. Cannot close them 
alternately. The tremor here preceded the 
paralysis, and this is also an important fact, as 
there is another disease in which the paralysis 
comes before the tremor. She has no dizziness, no 
pain in the head. Slight numbness in the right 
hand, with loss of sensibility. Observe when she 
walks how much weaker the right side is in com- 
parison with the other. The tremor is also mainly 
confined to the right side. 

Now this may be confounded with three diiFerent 
diseases, viz., multiple cerebral sclerosis, which 
if it were the case, the tremor would be developed 
whether she moved her hand or not, or without 
voluntary motion of any kind. In spinal 
sclerosis, no tremor. There is, however, another 
form, multiple cerebral spinal sclerosis, and this 
is the form which she has. If the disease com- 
mences in the spinal cord, the tremor precedes the 
paralysis ; if it takes its origin in the brain, vice vei'sa. 

Sclerosis means hardening ; the brain becomes 



hardened, multiple, or deceminated ; there are 
nodules of hardened tissue. To give you a familiar 
illustration, make a brain of putty, and place 
therein, at intervals, small round substances, mar- 
bles, for example ; these nodules or spaces give me 
a fair representation of decimated sclerosis. It 
here, then, exists as decimated sclerosis ; the para- 
lysis came before the tremor. She has had sclerosis 
beginning in the brain and descending to her 
spinal cord. In this form, owing to a slow chronic 
condition, the connective tissue, the neuroma dis- 
appears and becomes hard. If you cut through 
this you find the true brain elements are gone, the 
result of chronic inflammation. 

We pass now to the treatment : and these are 
difiicult cases, as you will discover. In the ma- 
jority of cases nothing more can be done than to 
palliate. "Where a syphilitic element can be dis- 
covered, large doses of potass, iodide will be found 
beneficial. This is not the case here, therefore, 
this drug would be useless. Here the disease was 
produced by violent emotion. What then can be 
the pathological link. The emotion remained and 
caused this chronic element. In such cases I have 
derived great benefit from the chloride of barium, 
in grain doses, three times daily ; she should use 
this for a long time, and under this influence she 
may get better. 

The actual cautery is productive of good efifects. 
There is good reason to hope that if it were used 
and repeated every two or three weeks, it might 
produce a good result. The morbid process in 
her case is situated in the ganglia at the base of 
the brain, the pons varolii the starting point. 

We will, therefore, place her upon the chloride 
of barium, one grain three times daily, and touch 
the nucha with the actual cautery, leaving it on 
about the fifth part of a second. It must be re- 
peated in two weeks, at which time we will see 
what progress she has made. 



LONG ISLAND COLLEGE HOSPITAL, 
BEOOKLYN. 

Reported for the Medical and Surgical Re- 
porter, by WiNPRED Wylie, m.d,, House 
Physician. 

Acute Nephritis. 

Oct. 25th, 1S78. Johannah Heart, aged 29; 
nativity, Ireland. Three weeks ago, after exposure 
to cold while washing, she was taken with a rigor, 
which was followed by fever, severe pain in re- 
gion of the kidneys and violent emesis. Patient 
had an almost constant desire to urinate, but was 
unable to pass more than a few drops at a time. 
When admitted to hospital, her face and limbs 
were badly swollen (oedematous), urine small in 
quantity, light in color, sp. gr. 1.009. Upon the 
addition of heat and nitric acid one-half its bulk 
coagulated. Microscopical examination showed a 
large quantity of epithelium from the tubules and 
urinary passages, as well as epithelial and blood 
casts. ' Upon physical examination of lungs 
numerous very fine moist rales were found, show- 
ing some oedema of lungs ; she also complained of 
pain in the chest. At 7" p.m. she was given fifteen 
minims fluid extract jaborandi, to be repeated 
every hour until she should perspire. Soon after 



¥ 



32 



Periscope. 



[Vol. xl. 



second dose she began to perspire, which soon be- 
came very profuse ; at the same time the saliva 
escaped from the mouth almost continuously ; this 
continued for some hours. 

Oct. 26th. Patient feels a great deal better ; no 
rales or pain in the chest. Kepeated the same 
treatment this evening, with like result ; also used 
dry cups over kidneys and lungs. 

Oct. 27th. Patient improving ; repeated jabo- 
randi, with a like result; continue to cup over 
kidneys once a day. 

Oct. 28th. Stopped the jaborandi ; oedema has 
entirely disappeared. 

Oct. 29th. Patient feels perfectly well. 

Oct. 30th. Slight cedema in lower extremities. 
Gave her three fifteen-minim doses of fluid extract 
jaborandi, with no result except to produce an in- 
creased flow of saliva. 

Oct. 31st. Eepeated the fluid extract jaborandi 
and increased amount up to sixty minims, but 
could not produce any perspiration. Examined 
urine ; found it light in color, sp. gr. 1.012, albumen 
about one-fourth its bulk. She was put upon — 
R. Tr. digitalis, .i^ij 

Sol. potassse citratis, .^ij 

Infusi buchu, q. s. ad ^iv. M. 

SiG. — Take two drachms every two hours. 

Nov. 1st. Improving. 

Nov. 4th. Eapidly improving. (Edema has 
entirely disappeared. 

Nov. 8th. Examination of urine shows it nearly 
normal. 

Nov. 10th. Discharged, recovered. 

Caseous Pneumonia, or Quick Consumption. 

"Walter Silverspare, aged forty-five. Nativity, 
Sweden. First mate. November 6th, 1878. Patient 
has had a cough for some time. About a month 
ago he was ill in the south, with a fever; while 
recovering from that he fell overboard, and re- 
mained in the water nearly half an hour. The 
next day he had a cough with slight fever, and for 
three weeks previous to his admission to the 
hospital he had been confined to his bed. When 
admitted he was very weak, pulse very small, weak 
and rapid, breathing fifty times per minute. 
Temperature 103°. He was also having involun- 
tary evacuations of bladder and rectum. On 



examination we found slight dullness over whole 
of left lung, except at the apex, where it was 
vesiculo-tympanitic ; at same place he had cavern- 
ous respiration and gurgles. Submucous rales over 
both lungs, most marked over the left lower lobe, 
gradually becoming firmer as we near the apices. 
Gave him, to bring up his pulse at once, spirits 
ammonise aromat. (thirty minims) hypodermically. 
For his general condition — 

R. Cinchonidise sulph., ^j 

Acid, nitro. mur., .^ij 

Aquae, q. s. ad ^iij. M. 

SiG. — One drachm every four hours. 

And half an ounce of whisky in two ounces of 
milk every two hours. 

Nov. 7th. Pales in left lower lobe are a little 
larger than they were last evening. Those in the 
right lung are clearing up slightly. Eespirations 
forty-six per minute. Temperature, 6 a.m., 102° ; 
7 P.M., 104. 

Nov. 8th. Patient about the same. Gave him 
two and one-half quarts of milk, and ten ounces 
of whisky daily. Temperature, 6 A. m., 102° ; 7 
p. M., 103J. Gave him, in addition to the above — 

R. Tr. nucis vomicae, ^j 

Ammonise carb., ,^j 

Aquae, q. s. ad ^iij M. 

SiG. — One drachm every three hours. 

Nov. 9th. Eales in left lower lobe very 
much larger. He is failing rapidly. Tempera- 
ture, 6 A. M., 102f ; 7 P. M., 105° ; respirations, 
sixty-five per minute. 

Nov. 10th, Eales in left lower lobe larger; 
those in right lung are not nearly so numerous, 
but are larger than when he was admitted. Tem- 
perature, 6 A. M., 102° ; 7 p. M., 103°. 

Nov. 11th, 6 A. M. Temperature, 103°. Died 
at 11 A.M. 

Autopsy. — Disclosed a large cavity in left apex, 
innumerable cavities throughout both lungs, but 
more particularly in the left lower lobe ; the cavi- 
ties were from the size of a small pea to that of a 
small walnut ; these cavities were filled with a 
creamy, puruloid matter. There was also innu- 
merable cheesy deposits throughout both lungs, 
which had not as yet undergone liquefaction. 



Editorial Department 



Periscope. 



The Use of Chloroform in Labor. 

Dr. J. M. Howie, of Liverpool, writes to the 

British Medical Journal : — 

There can be little doubt that the indiscriminate 
use of any anaesthetic during parturition is likely 
to prove inj urious in very many cases. Chloroform 
certainly both relaxes the uterine fibres and di- 
lates the minute blood-vessels, thereby retarding 



delivery and increasing the tendency to post- 
partum hemorrhage. Besides its power to prevent 
oxidation, it exercises an exhausting influence 
upon the nervous system. On this account, Avhen 
I am called to a case of extreme exhaustion, I en- 
deavor to expedite delivery (by forceps or other- 
wise), as far as possible, without the aid of anaes- 
thetics. 

The administration of chloroform " in the usual 
obstetrical fashion, namely, in small doses during 
the pains only, and after the commencement of the 
second stage," I have very seldom practiced during 



Jan. 1 1, 1879.1 



Periscope, 



33 



the last six years, and only in those cases where 
uterine action has been excessive and rapid. In 
other patients, I found that it lengthened the labor, 
increased the tendency to hemorrhage, and, on ac- 
count of the larger quantity administered, consid- 
erably prolonged the period of convalescence. One 
lady, the wife of a professional man, was so much 
injured by it as to present symptoms resembling 
those of puerperal mania. Nevertheless, it cannot 
be denied that chloroform is an immense boon to 
large numbers of lying-in women ; but in the ma- 
jority of such instances its administration ought to 
accompany the use of the forceps, Th© class of 
women (increasing year by year) in which such 
treatment ought to be resorted to early, comprises 
those whose heart is weak, and, therefore, liable to 
be injured by the intense strain produced by mus- 
cular effort. Tn such women, ergot is exceedingly 
injurious, for it increases the blood-pressure — (a) 
by promoting excessive uterine contraction, and 
(6) by contracting the minute blood vessels. Chlo- 
roform, on the other hand, lessens blood pressure 
by inhibiting uterine contraction and dilating the 
minute blood vessels. Then the early application 
of the forceps prevents such a strain upon the weak 
heart and vessels as would be likely to prove in- 
jurious. 

I cannot but think that it would be a safe rule 
only to administer chloroform in those cases where 
uterine a«tion is excessive, or where some artificial 
means of hastening delivery is contemplated, at an 
early period of the second stage. Since I adopted 
this rule, six years ago, I have had many hun- 
dreds of obstetric cases, and have not had a single 
case of troublesome post-partum hemorrhage in 
my own practice. 



The Surgical Treatment of Lupus. 

In an article by M. Hillairet, quoted in the 
London Medical Record, the writer says — 

It was Veiel who first introduced acupuncture. 
The method consists in pricking the surface of the 
lupus with needles, either in bundles, or fixed in 
the same handle, but separated from one another 
by some millimeters. These needles, before being 
used, should be heated to a red color. This plan 
is, however, at the present time much less em- 
ployed than the scraper and linear scarification. 
Voikmann invented the scraper, and published 
his proceeding in 1 870. It consists in scratching 
the surface of the lupus with curettes of different 
shapes, but generally of small dimensions. It is 
necessary, in order to aid the action of the instru- 
ment, to raise up all the lupoid tissue, and one 
may be satisfied with the result when the curette 
comes upon more resisting parts ; this is healthy 
tissue ; the operator should then stop. It is gen- 
erally necessary to repeat the operation one or 
more times a month, until the healing of the 
lupus is complete. Voikmann and Hebra both 
advise cauterization of the scraped surfaces with 
nitrate of silver. This method of Volkmann's 
gives very good results, but it is not applicable to 
all cases of lupus, and I more often employ linear 
scarification. To practice this, a needle, slightly 
flattened, with sharp edges, may be used. Or, 
following the example of Balmanno Squire, a 
scarificator with numerous blades, which he has 
expressly constructed, may be used. Pei'sonally, 



I find the needles most easy to manage, and I 
make the linear incisions separated by a few 
millimeters. I place my incisions in such a way 
that some are perpendicular to the others, and I 
repeat the operation one or more times a month, 
until the lupus is well. I have obtained by this 
practice very good results, and I believe that this 
method is destined to be of great service. It 
offers one inconvenience ; that is, it gives rise to 
hemorrhage, which may be very abundant, and in 
patients with frail constitutions this may be in- 
jurious. I should say a great deal of this loss of 
blood may be avoided by applying to the lupoid 
surfaces, before operating, some convenient anaes- 
thetic, and afterward by the immediate use of 
perchloride of iron ; this may be simply done by 
means of a piece of blotting paper, as recom- 
mended by Balm-anno Squire. Another recom- 
mendation of linear scarification is, that it can be 
more easily and more promptly repeated than 
cauterization. 



Copaiba in Cirrhosis and Jaundice. 

The value of copaiba as a diuretic and chola- 
gogue is not suflSciently appreciated. The following 
case, reported in the British Medical Journal, by 
Dr. B. J. Massiah, illustrates it — 

W. D., aged 37, a clerk, was a spirit drinker for 
four years, seven years ago ; and during the last 
four years and a half has had three prolonged and 
painful attacks of jaundice, with ascites and oedema 
of the lower limbs. On admission, three months 
ago, he was tawny, thin, and rather weak. He 
complained of constant pain in the umbilical and 
lumbar regions. His fluctuating abdomen meas- 
ured thirty-four inches in circumference, and the 
vertical hepatic dullness in the nipple-line was 
three inches. The urine was scanty, bilious, and 
exalbuminous. 

During the first month he took bitartrate 
of potash and compound jalap powder; and the 
abdomen increased two inches, the urine remaining 
scanty. Then, under a scruple of copaiba thrice 
daily, it rose on successive days, from one pint 
in twenty-four hours to three, four and five 
pints ; while the ascites began to subside. Once, 
for a fortnight, he took half a drachm of tincture 
of belladonna thrice daily, for the abdominal pain, 
and the quantity of urine fell below two pints daily. 
Since then, he has returned to the copaiba, and his 
urine has averaged three or four pints daily. The 
abdomen now measures thirty-three inches in cir- 
cumference, and his general health is much im- 
proved. 



On Albuminous Substances in the Urine. 

An interesting paper on the albuminous sub- 
stances which occur in the urine in albuminuria 
has been contributed to St. Bartholomew's Hospital 
Reports, for 1877, by Dr. Lauder Brunton and Mr. 
D'Arcy Power. In it they deal with the subject 
of differences in the coagulating point of albumen 
(or albumm, as it should be more correctly written, 
to distinguish egg-albumen from the serum-albu- 
min of the blood) in the urine of Bright's disease, 
and also with the question whether there are other 
forms of albumin met with in it besides ordinary 
serum-albumin. We shall only give results here, 
and leave our readers to refer to the original paper 



34 



Periscope. 



[Vol. xl, 



for details. In answer to the question, does the 
coagulating point of the albumin in albuminuria 
vary much ? they found that it ranged from 144° 
to 180° Fahr. in five cases of different forms of 
" Bright's disease," and they showed that this dif- 
ference partly depends, as was previously known, 
on the acidity and the amount of neutral salts in 
the urine, which lower the coagulating point, and 
partly on the amount of urea present, which raises 
it. The effects of the urea is so great that when it 
reaches 25 per cent, of the mixed solutions of 
serum-albumin and urea, coagulation is entirely 
prevented. On the other hand, the coagulating 
point is lowered by uric acid. Dilution of albu- 
minous urine with water, to a specific gravity of 
1.005, lowers the coagulating point, but does not 
render it constant. The diflferences in the coagu- 
lating point appear also to be partly due to the 
existence in the urine not only of serum-albumin, 
but also of the products of pancreatic digestion, 
which coagulate at higher temperatures the further 
the process of digestion has advanced, though 
their coagulating point is much lower than that of 
serum-albumin, about 160*^ Fahr, The effect of 
food on the coagulating point was experimented 
on in several cases, and was found generally to 
lower it, though not invariably. The coagulating 
point is not sufficiently constant in different dis- 
eases attended with albuminuria to infallibly indi- 
cate the nature of each disease ; but the authors 
remark that "the great differences between the 
urine of a case of waxy kidney, in which the 
coagulating point was about 162° Fahr., and one 
of chronic Bright's disease, where it was 132° 
Fahr., cannot be regarded as unimportant." 



Ergo tine in Acute Ophthalmia. 

Dr. Planat, of Nice, states, in the Journal de 
Therapeutique, that he has found ergotine act with 
efficacy and promptitude in proportion as oculo- 
palpebral phlegmasise are simply inflammatory. 
In blepharo-conjimctivitis the improvement is first 
observed in the conjunctiva ; and in keratitis, 
although still very active, it is a degree less so 
tlian in the more superficial affection??. It is also 
of great service in iritis, rapidly subduing the 
acute manifestations and preventing their ex- 
tension to the external membranes of the eye. 
When these last are the seat of a chronic fluxion 
dependent on a scrofulous or dartrous diathesis, 
ergotine, Avithout influencing the constitutional 
affection, acts none the less efficiently on the in- 
flammatory element — a fact of importance, as by 
generally preserving the eye from plastic deposits, 
corneal ulcers, and consecutive staphylomas, it 
allows of the treatment for the diathesis being 
more promptly put into force. The formula which 
Dr. Pi an at recommends is from one to one and a 
half gramme of ergotine in twenty of glycerine 
or rose water, of which from eight to ten drops are 
to be inserted in the eye every two hours. Where 
there is violent inflammation of the eyelidsor dis- 
tention of the conjunctiva, a rag wetted in this 
mixture should be left on the parts for some hours. 
In general, two or three days suffice for the sub- 
dual of the most intense blepharo-conjunctivitis. 
Dr. Planat has employed the ergotine in this 
way, with invariable success, for several years 
past. 



Diflferences Between Zymotic and Septic Poisons. 

These are well set forth in a recent lecture by • 
Dr. Eeginald Southey, of London. The zymotic 
contagium, be this what it may — some modified 
blood or soluble animal cell, some fungus or low 
vegetable germ, zoospore or microspore — requires 
cooking or hatching for a certain period of time in 
the individual who has received it, before any 
apparent change or reaction can succeed. Some 
period of incubation must elapse, during which 
the poison infects or impregnates the whole system, 
before this manifests its j)resence by symptoms ; 
but when the reaction is manifested, it is general 
at once throughout the body. So soon as the 
poison begins to work its changes, indefinite symp 
toms may arise, such as are common to all grave 
blood changes, and are non-appointing. You will 
have often heard me say at ihe bedside that a patient 
appears to me suffering from a general reaction to 
some one of the exanthemata contagia, which one 
I cannot tell until the rash comes out. 

Three stages may thus be distinguished in the 
history of zymotic poisoning. (a) A dormant 
stage without symptoms ; (6) an incubating stage 
with general symptoms ; (c) a specific stage with 
special appointing symptoms. 

No such separate stages can, I think, be ob- 
served in disease produced by septic poison. It is 
true that the poison of erysijielas, septicaemia, 
hydrophobia, sometimes lies latent in the body 
into which it has been inserted, but this latent 
period is non-essential; nay, rather it may be 
regarded as accidental, for from the first instant 
the poison reaches vulnerable surfaces, the reac- 
tion commences, the body is forthwith infected. 
A late or deferred reaction is apparently only 
due to encapsulation of the poison at the poison 
wound, its separation really from the body by a 
limitation barrier. Within such a capsule the 
poison germs lie like seeds inside a seed-case. 
Furthermore, in septic disease the i-eaction pro- 
cess first manifests itself at the point where the 
virus is inserted, and spreads from this focus, 
gathering force as it goes.' There is no incubating 
stage — the specific symptoms follow at once. We 
perceive next that the quantity of virus or poison 
inserted makes absolutely no difference to the 
total sum of the reaction or specific symptoms 
provoked in the instance of zymotic disease, 
whereas both the form and quantity of the septic 
poison materially influence the course and gravity 
of the reaction induced. Finally, in both septic 
and zymotic disease we perceive a conflict be- 
tween the stability of the poison entity and the 
stability of the person poisoned, but a conflict with 
this remarkably difierent issue, that the zymotic 
poison always vanquishes the body and leaves its 
stamp or mark upon it, whereas the septic poison 
is either vanquished and cast out, or obtains pre- 
dominance, corrupts and destroys the individual. 



Vomiting After Operations. 

Prof. Verneuil, recently made some observa- 
tions at the Soci6t6 de Chirurgie on the occur- 
rence of obstinate vomiting after operations and 
wounds. He did not allude to vomiting that 
might be dependent on eating too soon after- 
ward, impure chloroform, regurgitation of the 



Jan. II, 1879] Reviews and Book Notices. 



35 



saliva, etc. In the cases he has in view, the 
patients vomit saliva, bile, or ingested sub- 
stances, without apparent cause; they become 
fatigued and anxious, and dare not eat or drink ; 
while the efforts in vomiting sometimes induce 
oozing of blood from the wound. Prof. Verneuil 
meets with three or four such cases in his wards 
annually. This form of vomiting seems especi- 
ally to occur in " alcoholics," as also in subjects 
of disease of the liver and kidneys, and in per- 
sons of bad digestion. The prognosis in these 
cases is not usually very serious, though some 
times it may cause uneasiness. Ice has been 
given with success, and io some patients mor- 
phia injections arrest the vomiting. It is of 
importance that the patients should be nour- 
ished; but wine, as wdl as milk, is badly 
tolerated. What tfucceeds best is ice, mucilaged 
and alcoholized water and pepsine, in the dose 
of fifteen grains morning and evening. Prof. 
Verneuil's object is to show that the cause of 
obstinate vomiting after operations is an an 
terior dyspeptic condition, and that frequently 
there are alterations in the internal organs, 
chloroform only playing quite a secondary part 
in the production of the vomiting. 



Reviews and Book Notices. 



NOTES 



ON CUEEENT MEDICAL 
LITEEATUEE. 



Dr. J. W. Sherfy, late an officer of our 

Navy, now of London, has republished from 
the Temperance Record an article on the an- 
tagonii^m of alcohol and diphtheria. It ap- 
proves and endorses Dr. Chapman's well known 
views on this subject. 

The American Naturalist^ for December, 

contains a well-written article on the hygienic 
influence of plants, by Dr. J. M. Anders. It 
is the best summary of the subject we have 
seen. 

In No. 9 of Schmidt's Jahrbiicher, Dr. 

B. Segnitz, of New York, has a communication 
on idiopathic asthma, principally concerning 
its history. He does not speak sanguinely of 
treatment. Moderately large doses of camphor 
have proved the most effectual in his hands. 

The report to the Pennsylvania State 

Medical Society of the Philadelphia County 
Medical Society, on Epidemics and Meteorology, 
by the Chairman, Dr. Benjamin Lee, makes a 
pamphlet of thirty pages. It ia a carefully 
prepared document. 

Dr. Thad. M. Stevens, of Indianapolis, 

has published an article of four pages on 



" The History of and Necessity for Medical 
Legislation in Indiana," which it is to be hoped 
will stir up the profession of that State to 
active work. 

The Annual Eeport of the Columbia Hos- 
pital for Women, and Lying-in Asylum, has 
reached us. It will be remembered by many that 
an anonymous correspondent of a Louisville 
journal preferred numerous and grave charges 
against the surgeon in charge, and they were also 
filed in the Department of the Interior, A com- 
mittee of eight physicians were appointed to in- 
vestigate them, and it is but just to quote the fol- 
lowing extract from their report : — 

" In carefully reviewing the testimony adduced, 
a work absolutely necessary in order to arrive at 
the result desired by the Board of Directors, the 
Advisory Board have had the conviction forced 
upon them that, not only are their conclusions, as 
previously given, entirely just in every particular, 
but that Dr. Murphy is entitled to the highest com- 
mendation for the fidelity and conscientious dis- 
charge of his duty ; and, further, the Advisory 
Board feel that they would have but illy performed 
their task should they fail to express their appre- 
ciation of the professional skill of Dr. Murphy, 
and their entire confidence in his ability to meet 
any emergency that may arise in an institution of 
this kind." 

A thoughtful and able article on the pro- 
phylaxis of puerperal convulsions appears in a 
reprint from the Toledo Medical and Surgical 
Journal, by Dr. E. S. Dunster, Professor of mid- 
wifery at Ann Arbor. His opinion of the prac- 
ticability of prophylaxis may be judged from 
this extract, toward the close of his paper : " I 
cannot close this paper without again expressing 
the belief that medical art now furnishes a cer- 
tain method of averting, in very many if not the 
large majority of cases, the dangers consequent 
upon the' albuminuria of pregnancy, and that it 
should be our constant aim to early recognize the 
condition, so that the treatment may be applied in 
season." 

The Annual Eeport of the Surgeon General 

United States Navy, gives the usual statistics 
and urges upon Congress the importance of pro- 
viding for the publication of the Index -Catalogue, 
which it is to be hoped will promptly be done. 
The Surgeon General adds, "Of its great 
utility, not only to the medical profession, but 
through that profession to the people at large, 
there can be no doubt, and there are special rea- 
sons why it should be placed beyond the reach of 
casualty, and made accessible to physicians with 
as little delay as possible." In regard to the 



36 



Reviews and Book Notices, 



|Vol. xl. 



present medical staff he says, " It has not been 
found practicable to fill existing vacancies, but 
seven candidates having been found qualified for 
appoin tment as Assistant Surgeons in the past ten 
months. Even were the Corps filled to its maxi- 
mum, the present disposition and occupation of 
troops creates a necessity for additional medical 
aid, and it has been found expedient, economical, 
and in every instance absolutely necessary, to 
employ physicians under contract to meet such 
demands ; such iemployment terminates when the 
emergency ceases." 

Dr. H. M. Paine, of Albany, has favored us 

with several pamphlets, etc., relating to the " ad- 
vanced" position of modern homoeopathy, the 
registration of disease, etc. To discover the follies 
of " dynamization " does not, we confess, seem a 
wonderful thing ; but we do feel surprise that a 
gentleman of Dr. Paine's real though tfuln ess and 
ability should continue to believe as much non- 
sense as he yet does. 

Dr. George M. Beard has done a good 

thing by exposing the palpable frauds of the so- 
called "Mollie Fancher Case," the Brooklyn 
seeress, who has been befooling the public, and 
even several respectable members of the profes- 
sion, for years. Dr. Beard suflSciently exposes the 
humbug by stating that the seeress and her medi- 
cal advisers decline the test of a properly guarded 
scientific examination. Verb, sat sap. 



BOOK NOTICES. 

Diifsrential Diagnosis : A Manual of the Compara- 
tive Semeiology of the more Important Diseases. 
By F. De Havilland Hall, m.d., Assistant Phy- 
sician to the Westminster Hospital, London. 
American edition, with extensive additions. 
Philadelphia, D. G. Brinton, 115 South Seventh 
street. 1 vol., 8vo, cloth, pp. 205. Price $2.00. 
The recognition of disease is the indispensable 
requisite to successful treatment ; hence, the great 
attention which is paid to diagnosis by the most 
eminent medical teachers. In the work before us, 
Dr. Hall, himself an able and successful instructor 
in one of the London medical schools, presents a 
series of tables setting forth the differential diag- 
nosis of the more common diseases. The British 
Medical Journal^ in a review of the work, says : 
" These tables do not partake of the objectionable 
type of books brought out by " grinders ;" they are 
invaluable aids by the bedside, enabling the prac- 
titioner and student readily to compare signs met 
with in disease with those observed in health." 



The American editor has expanded the plan of 
Dr. Hall, while adhering to its excellent method, 
to include several groups of diseases not appearing 
in the English work. He has, moreover, devoted 
especial attention to collating and presenting the 
early signs of disease ; the 'pathognomonic symptoms 
of disease, and the peculiarities of disease in the 
United States. 

Thus we have three pages filled with the symp- 
toms of exanthematous fevers which precede the 
eruption and enable the physician to predict its 
form and the nature of the disease. For the diag- 
nosis of incipient phthisis, sixteen difierent signs 
other than those supplied by the usual rules of 
auscultation and percussion, are enumerated. Three 
pages are assigned to the early signs of Bright's 
disease. And the prodromata of that insidious and 
terrible disease, general paralysis, are carefully 
drawn. 

The scope of the work takes in both general 
and local diseases. Under the former there are 
chapters on fevers and diseases of the blood ; under 
the latter are diseases of the nervous system, of the 
respiratory system, of the circulatory system, of 
the digestive system and of the urinary system. 
While, of course, various diseases of rare occurrence 
and slight importance are omitted, it will be 
found that almost all which the practitioner meets 
with, and which are liable to be confounded, are 
represented. The tabular and comparative ar- 
rangement adopted offers peculiar facilities for 
presenting a great deal of matter in a singularly 
compact form. Hence it is that in a convenient 
volume of but little over two hundred pages a 
vast amount of information is condensed. 

We also observe that the latest contributions to 
the subject have been levied upon, and though 
preference is avowedly given to American authors 
for the description of diseases, the important works 
of the latest German, French and English authors 
are freely consulted. 

The paper, print and binding are all of the best, 
and, both in matter and form, the work will 
scarcely fail to please all who make use of it. 

Beitr%e Zur Entwickelungsg-eschichte des Men- 
schen, des Saugethiers und des Vogels. Von 
Fanny Zeiller g. Elser. 

Contributions to tlie History of the Development of 
Man, Mammals and Birds. By Fanny Zeiller 
Honorary Member of the Free German Hoch- 
stift, Frankfort on the Main. J. G. Weiss, 
Munich. 
In this work, published at Munich last year^ 

we have a noteworthy contribution to the science 



Jan. II, 1879.] Reviews and Book Notices. 



11 



of embryology, by one of those erudite women who, 
within the past few years, have so triumphantly 
vindicated the aptitude of their sex for the se- 
verest studies. The work is in the form of an 
Atlas, containing ten large full-page plates, exhibit- 
ing in ninety-seven different figures, drawn, with 
scrupulous fidelity, from nature, the stages of de- 
velopment of the human embryo, illustrated by 
numerous comparative examples of its growth in 
other mammals and in birds. The technical per- 
fection of the work is apparent on the most super- 
ficial examination, and that it is calculated to 
give very faithful representations all familiar with 
such subjects will readily recognize. 

But the criticism which will be at once pro- 
nounced upon the book is, that it is what the 
Germans call tendenzios; in other words, the 
authoress has undertaken this enormous labor to 
support certain views of a theoretical character, 
rather than simply to represent, with the cold in- 
difference of pure science, the occurrences that 
transpire in that most secret arcanum of nature, 
the fertilized ovum. This she frankly avows in 
the introductory remarks. 

Our readers are, no doubt, aware that the adapt- 
ation of means to end, the enforced relation of 
cause to effect, and the evidence of design and 
purpose, are jointly and severally denied and de- 
rided by advanced scientific thinkers, and nowhere 
more boldly and absolutely than in Germany. 
The unity of life in the individual, and the indis- 
soluble communism of the vital acts, from the first 
segmentation of the yolk to the last gasp of death, 
is not admitted. It is in the defence and illustra- 
tion of this rejected oneness of the individual life, 
that Mrs. Zeiller presents the rich store of facts 
she has accumulated ; but in doing so, has taken 
pains to re-examine, and often to correct, the 
statements regarding the development of the 
embryo, as given in the leading text-books of 
KoUiker, Bischoff, Hakel, and others. 

Whether we concede or not that she has estab- 
lished the underlying principle for which she con- 
tends — and on this point we do not consider that 
either ourselves or this generation, is capable of 
pronouncing the final word —no one can deny her 
the highest credit for carrying out so laborious 
an investigation with such excellent results. 



I 



Transactions of the Minnesota State Medical So- 
ciety, 1878. pp. 186. 

In these Transactions the reports of the com- 
mittees and the discussions on them are given at 
onsiderable, at times unnecessary, length, as many 
"pages could have been abbreviated one-half with- 
out loss to any one. The Report on Surgery is 



especially full, and numerous cases are cited. The 
leading essays are by Dr. Franklin Staples, on 
" Fracture of the Femur ; " Dr. W. W. Mayo, on 
" Purpura Hemorrhagica ; " and by Dr. J. B. Mc- 
Gaughey, on "Venereal Diseases." They are all 
three excellent papers, the one first mentioned 
particularly showing a thorough study of the sub- 
ject. 

The Principles and Practice of Surgery. By John 
Ashhurst, Jr., m.d. Second eiition. En- 
larged and thoroughly revised. With 542 
illustrations. Philadelphia, H C. Lea, 1878. 
pp. 1040. 

The science of surgery has grown so greatly 
that even a volume of more than a thousand 
pages, such as the one before us, demands on 
the part of the author the most judicious com- 
pression and selection to present its various 
branches with adequate fullness. This Dr. 
Ashhurst has felt, and has at once acknowl- 
edged that in some directions, as in diseases of 
the eye and the ear, any attempt at conaplete- 
ness is out of the question. By this discretion 
he has allowed himself more room to discuss 
those general principles and common accidents 
and diseases, a knowledge of which must make 
a part of the education, not merely of the spe- 
cialist, but of every practitioner of medicine. 

While our space does not allow us to enter at 
length in an analysis of his work, the several 
articles we have perused in it have convinced us 
that it will bear very favorable comparison with 
any other. This, too^ is shown by the fact that 
a second edition has been called for. The 
author has taken the oppprtunity to give the 
whole a thorough revision, and made a large 
number of important additions. 

A Manual of Physical Diagnosis. By Francis 

Delafield, m.d., and Charles F. Stillman, m d. 

New York, Wm. Wood & Co., 1878. 4to, pp. 

30. 

An interleaved quarto of thirty pages, re- 
hearsing the known and established rules of 
diagnosis of thoracic diseases, in a simple form, 
readily comprehensible by junior students ; this 
will, no doubt, be found by such a very conve- 
nient work of instruction. Appended to the 
manual is a colored superimposed plate, giving 
the location of the contents of the thorax and 
abdomen ; a once very popular plan of convey- 
ing information which has been little resorted 
to of late years. 



38 



Editorial, 



[Vol. xl. 



THE 



A WEEKLY JOUE]JAL, 

Issued every Saturday. 



D. G. BEINTON, m.d., Editor. 



The terms of subscription to the serial publi- 
cations of this office are as follows, payable in 
advance : — 

Med. and Surg. Reporter (weekly), a year, $5.00 
Half- Yearly Compendium of Med. Science, 2.6C 
Beporter and Compendium, ... 7,ot 
Physician's Daily Pocket Record, - • 1.50 
Beporter and Pocket Record, - - - 6.2b 
Beporter, Comp. and Pocket Record, - - SSt 

For advertising terms address the office. 

Marriages, Deaths, and Personals are inserted 
free of charge. 

All letters should be addressed, and all checks 
and postal orders drawn to order of 

D. G. BrINTON, M.D., 

115 South Seventh Street, 

Philadelphia, Pa. 

A BATTLE OF THE GIANTS OVER EVOLUTION. 

Those great lights of science, Professor EuDOiiPH 
ViECHOW, of Berlin, and Professor Haeckel, of 
Jena, have been indulging in a set-to which has 
been making the scientific atmosphere of Germany 
sulphureous with the smoke of the combat. 

The veteran Berlin pathologist has not often 
been accused of religious bigotry ; indeed, he has 
usually been held up by the Particularist and 
Eomish press as a frightful exemple of the scien- 
tific atheist and modern infidel. But his time has 
come, and Haeckel now points him out as a reli- 
gious fanatic ! The duel arose in this wise : — 

At the last meeting of the German Association 
for the Advancement of Science, Professor 
Haeckel delivered an able address, in which the 
theory of the evolution of all existing organism 
from a single organic cell had been advanced as 
an almost self-evident conclusion, and as suffi- 
ciently established to permit it to be taught in 
every school. A second and scarcely less daring 
proposition had been laid c'own by Naegele, to 



the efiect that the province of mind should not 
only be extended from animals to plants, but that 
we should finally pass over from the organic to the 
inorganic world with our conceptions of the nature 
of mental operations. 

To these propositions Professor Virchow entered 
a powerfully written protest. He pointed out that 
the theory of evolution is so completely at vari- 
ance with views that have long been generally 
accepted that it constitutes a sort of new religion, 
and must be imported as a whole into the schools ; 
for, even if not ordered to be introduced, the 
schoolmaster who accepted it would necessarily 
have his mind so tinged with the doctrine that it 
would influence all his teaching and force its own 
way. But the evolution theory is still on its trial ; 
it has been extended far beyond the limits in 
which it was bounded by the caution of its origi- 
nator, and on a certain basis of solid fact a great 
superstructure of hypothesis has been raised. So 
with Professor Viechow's own well-known form- 
ula, that every cell is derived from a cell ; there 
have not been wanting others who not merely ex- 
tended this statement in the organic world, beyond 
the bounds to which he had restricted it, but trans- 
ferred it beyond the bounds of organic life— as 
holding good universally ; and he states that he 
has received the most extraordinary communica- 
tions from America and Europe, in which the 
whole sciences of astronomy and geology were 
based on the cell theory. Such hypotheses are 
clearly beyond and outside of the educational sys- 
tem. They may be suggestive and useful to the 
Professor, but they are utterly unailapted and 
harmful to the student. For him and for the 
general public the distinction between what is ab- 
solute fact and what is only presumption should be 
sharply defined and clearly recognized. The 
teacher should teach that alone which he knows 
to be true and irrefragable ; for it must not be for- 
gotten that, when the public see a doctrine which 
has been presented to them as established and 
claiming universal acceptance proved to be faulty, 
many are led to lose faith in science, and to re- 
proach it with insincerity and instability. 

These utterances were eagerly seized upon by the 
religious press of Germany, and published in a 



Jan. II, 1879.] 



Notes and Comments, 



39 



more or less complete form, as " the recantation of 
the great materialist." 

But Haeckel, who seems to be like one of our 
own shining medical lights, " a terrible fellow in a 
controversy," lost no time in polishing his weapon 
and rushing forth. His pamphlet, Freiz TFissew- 
8chajt undfreie Lehre, is full of the sharpest points. 
He claims that Viechow is ignorant of the 
common facts of science, that he is getting old and 
weak in the head, and that he is dabbling too 
much in politics to keep up with medicine. As to 
the evolution of species from each other, he quotes 
numbers of undoubted examples. He, Haeckel, 
has himself shown some, in his monograph on the 
"Calcareous Sponges," his investigations leading 
him to the conclusion that, according to the taste of 
the observer, 3 or 21, or 111 or 289, or 591 species 
may be made, indicating in no uncertain manner the 
probability of the transformation of species. All 
this and much more, as the evidence derived from 
embryogeny, and from the presence of rudimen- 
tary organs, Virchow either ignores or passes 
lightly over. Indeed, Virchow, he says, is not 
now qualified to form an opinion upon such points, 
since his labors of late years have been political 
rather than biological. Just such a deviation from 
the paths of science was witnessed in the case of 
Ernst von Baer, and with a similar limitation 
of the mental horizon. Both began life as great 
reformers of the then prevailing doctrines, both 
failed to bring their knowledge up to the timeSj 
and "hence the authority of both in their later 
life fell away." " Virchow does not know how 
ignorant of morphology he is." 

The controversy, as it stands, may be said to be 
a pretty one ; and we shall look with interest for 
ViRCHOw's reply ; meanwhile he has dropped 
politics, avowedly, to address himself with all his 
energy to science. 

We are very far from believing that his day of 
active thought has passed away. It is an impu- 
tation often laid at the doors of men advanced in 
life, that their powers are failing, when such is by 
no means the case. We shall be surprised if 
Virchow does not reply in a manner to show 
that his eye is not dim nor his strength abated. 



Notes and Comments. 

The Use of the Actual Cautery. 

Dr. Agnew, in his "Surgery" (p, 76), character- 
izes the actual cautery as " a rude weapon of tor- 
ture," an expression that we read with surprise, 
and cannot but believe is erroneous and unjust. It 
is an indispensable and most valuable implement 
at times. That eminent surgeon, Mr. Henry 
Lee, of Guys Hospital, London, has an article in 
a late number of the Lancet, on. the value of the 
hot iron as a styptic, etc. We allow ourselves 
two quotations from it : — 

"Before the introduction of an?esthesia into 
surgical practice, the use of the actual cautery was 
justly regarded as a barbarous and cruel proceed- 
ing. The traditions of one age descend to the next, 
and the application of a hot iron to the body is 
still regarded by the public, and even by some 
members of our profession,' as a thing not to be 
tolerated in scientific surgery. All objections to 
the use of the actual cautery vanish, however, so 
soon as it can be said that it . can be used without 
giving pain. * -x- * 

" The actual cautery has the great advantage of 
closing the veins as well as the arteries, and thus 
removes one of the gravest sources of anxiety to 
the surgeon, inasmuch as the great danger in sur- 
gical operations arises from the absorption of 
septic agents through unclosed veins. The liga- 
ture of a vein, as is well known, is not unattended 
with risk, for the obvious reason that during the 
time that the ligature is separating a certain 
amount of suppuration necessarily takes place, and 
the products of that action may give rise to septic 
absorption. The actual cautery, therefore, pos- 
sesses a great advantage over the ligature, as far as 
the veins are concerned. The danger of blood in- 
fection, though in a much less degree, obtains 
when an artery is tied. lii a vein the current of 
blood is toward the centre of the circulation, and 
in an artery from it. When mischief arises from 
the cause mentioned, after an injury to an artery, 
the eflfects are usually seen in the peripheral cir- 
culation. When venous absorption takes place, 
the results are generally manifested in the central 
organs." 

We also note that in the Bulletin de Therapeu- 
tique, October 15th, Dr. Trudeau states that in Dr. 
Labb^e's practice most excellent effects are ob- 
tained from the employment of the actual cautery 
in the treatment of diffused phlegmon. The treat- 
ment consists in applying numerous and deep 
cauterizations in the incisions which have been 
practiced in the phlegmon. No case should be 
despaired of until this treatment has been applied, 



4° 



Notes and Comments 



[Vol. xl. 



an abatement of all the severe symptoms usually 
occurring, the pain and fever very rapidly disap- 
pearing. Usually the cure is complete. 



Mortality from Alcohol and other Causes. 

Dr. Thomas Morton, of London, has presented, 
in the Medical Press and Circular, some remark- 
able statistics of the comparative mortality from 
alcoholism and other diseases, in England and 
Wales. He gives the following list of the causes 
of death, arranged in the order of their fatality. 



Bronchitis 

Phthisis 

Heart Diseases 

Atrophy and Debility. 

Old Age 

Convulsions 

Pneumonia 

Diarrhoea 

Apoplexy 

Cancer 

Paralysis 



54,055 
51,775 
30,481 
14,364 
25,461 
25,408 
24,492 
21,781 
13,215 
11,604 
11,994 



21,603 

33,374 

23,878 

3,413 

1,919 

52 

8,828 

1,833 

9,558 

10,719 



The deaths due directly or indirectly to alcohol, 
confining it to the period of life from twenty-five 
to seventy-five years, he carefully calculates at the 
alarming total of 39,287 ! 



The Development of the Graafian Follicles During 
Pregnancy. 

Contrary to the opinion then prevailing, and con- 
trary to that now generally taught (for example, 
Barnes' "Diseases of Women," p. 28), the late 
venerable Professor of Midwifery at the Jefferson 
Medical College, Dr. Charles D. Meigs, used to 
teach that the development of the Graafian fol- 
licles continued uninterruptedly during pregnancy. 
This opinion has been confirmed by some re- 
searches and post-mortems made by Dr. Slaviansky, 
which we find in the Med. Centralzeitung, Oct. 30th. 
A woman of twenty-four years, who died suddenly 
in the third month of pregnancy, displayed follicles 
on the point of bursting, and recent corpora lutea. 
This may be said to decide a question of consider- 
able physiological interest. 



The Physiological Action of CoiFee. 

Prof. Binz has been making some new experi- 
ments on this subject. He found that very large 
doses not only raised the temperature, but caused 
death by convulsions; but the latter could be 
averted by artificial respiration. Moderate doses 
of caffein raised the blood-pressure, the effect 
being the same whether the pneumogastric nerves 
are divided or not. Professor Binz has also exam- 
ined the effect of caffeoon, the nams given by 
]5outron and Fremy to the volatile products de- 



veloped in the coffee-bean by roasting, and he 
finds that it acts, like caffein in moderate doses, as 
a stimulant to the brain, the heart, the respiration, 
and the heat-producing apparatus. He agrees 
with Hoppe-Seyler and Voit, that an ordinary in- 
fusion of coffee slightly increases rather than di- 
minishes tissue-change. In any case, the influence 
it exerts in this direction is very trifling. The 
potassium salts contained in coffee are probably of 
no physiological importance. 



The Treatment of Sprains. 
Mr. Dacre Fox, an English surgeon to a large 
railway company, who has had considerable ex- 
perience of this form of injury, says that in the 
more severe cases he finds that after a few days of 
fomentation the best treatment is regulated pres- 
sure by means of carefully adjusted pads and 
large plasters of a special shape, varying accord- 
ing to the particular joint involved. By this plan 
he feels sure that it is possible to control the effu- 
sions into the sheaths of the tendons and adjacent 
structures, to lessen the pain, and to shorten the 
duration of treatment. 



Solubility of Chloral in Fatty Bodies. 
M. Catillon, in a communication to the Societe 
de Therapeutique, observed that the ready so- 
lubility of chloral in considerable proportions in 
fatty substances is not generally known, and may 
often prove of great utility in practice. One part 
of the hydrate is soluble in two of oil. The 
formula which he recommends is chloral 6 and 
oil of sweet almonds 30 parts ; or chloral 6, lard 
27, wax 3 parts. On the same principle, we may 
make plasters, bougies or suppositories according 
to the following formula : chloral 1, white wax 2, 
and butter of cacao 2J parts. 



The Pathology of Diphtheria. 

It is justly remarked by a writer in an English 
contemporary that the researches into the intimate 
pathology of diphtheria have as yet been to a large 
extent abortive. Many observers, such as Oertel, 
Letzerich, and Nassilloflf^ have asserted the con- 
stant presence of a specific growth of a lowly 
organism, of fungoid or bacteroid character, but 
their observations are mutually conflicting and in- 
consistentj and have been contradicted by equally 
skilled observers. But if in any of the specific 
contagious diseases we may anticipate the final 
discovery of an independent growing organism, we 
may perhaps look for it with more hope of success 
in diphtheria than in any other, seeing what a 
strong vitality the contagion displays under suit- 
able conditions. 



Jan. II, 1 879. J 



Correspondence, 



-9 

41 



Correspondence. 



The Contagion of Yellow Fever. 
Ed. Med. and Surg. Reporter: — 

I notice in Reporter, November 30th, an 
article on yellow fever, reported by G. L. Wil- 
kins, M D., whicli contains the opinions of various 
physicians in regard to its origin, mode of conr 
veyance to the human system, etc., whether by 
water or air, etc. It seems to me that it is a very 
plausible theory to believe that both water and air 
are the means through which the poison is carried 
into the system ; therefore it seems to me to be 
rather a useless controversy to lay the cause of its 
conveyance on either the one or the other of 
nature's products. I fully coincide with Dr. J. S. 
Lynch in his views as to the origin and non-con- 
tagiousness of the yellow fever. If the fever is 
carried into the system by water, and not air, why 
is it that so many escape the infection who remain 
out of the city at night, go in every day, drink the 
water, and yet remain free from the disorder, 
when most of those who remain in the town at 
night are taken down ? Surely, this seems to show 
that water is not the only means by which the 
poison enters the system. In Savannah the above 
facts were the case as a rule. 

Dr. Evans believes yellow fever and bilious re- 
mittent fever to be one and the same disease. In 
this I beg leave to differ, for the one generally 
confines itself to towns or places which have bad 
air, etc., and seems to require for its propagation, 
the presence of a certain degree of heat for a stated 
time, and the conditions of moisture and unsani- 
tary conditions, while the other is endemic to the 
country, where pure air abounds, and occurs to the 
residents year after year. Did any one ever know 
the yellow fever to spread through a farm house 
located in a perfectly pure atmosphere ? The 
symptoms are certainly not alike in every respect, 
though the autopsies may be. I grant, if one takes 
up a treatise on each affection, it is difficult to see 
the difference between the two diseases ; but let 
one see both infections, and I think he can tell the 
difference. • One does not observe, as a general 
thing, that peculiar bloodshot look about the eyes, 
nor, as I observed in the Savannah Hospital, that 
whiteness of tongue, in bilious fever, as in the other 
disorder; nor have I seen in Florida that ten- 
dency to suppression of urine, or hemorrhagic dia- 
thesis, so common in yellow fever, prevail in 
bilious fever. I don't say that hemorrhages, etc., 
may not be present in bilious fever sometimes, but 
I mean as a general thing. 

In looking over my notes of cases of yellow 
fever, I find that in Savannah the pulse and tempera- 
ture were nearer together than is common in 
bilious fever. In not one do I find the pulse to 
rise to 100, but the temperature ranges from 102^^ 
to 104 J. The tongue in bilious fever is almost 
always coated with a yellowish fur; in yellow 
fever, white. Is not the pulse much higher in 
bilious fever than in yellow fever, and do we find 
the heat of body and pulse so near together in 
bilious fever ? It does require some discrimination 
to decide between the disorders where both prevail, 
and should yellow fever and remittent prevail in 
the same place in Florida, it would be hard to 



diagnose the one from the other, unless the prac- 
titioner had seen both, as I have. I will give a 
short report of two bad cases, one yellow fever, the 
other bilious remittent. 

Yellow Fever. — T. G., a native of Ireland, ad- 
mitted to hospital in Savannah, September 19th, 
1876 ; fever high ; pain in epigastrium, head and 
legs ; eyes sufiiised and congested. Treatment : 
Blister to stomach, quinine in large doses, bath. Re- 
mission followed by vomiting, suppression of urine, 
not satisfactory ; violent delirium ; had to be tied 
down ; black vomit ; death. Post-mortem. Adipose 
tissue abundant ; muscles very red ; liver partly box- 
woo 1, fatty degeneration of, engorged; stomach 
congested and black vomit visible in small and 
large intestines, which were congested ; unhealthy 
bile and mucus ; kidneys congested ; spleen 
normal size, but exceedingly rotten and soft. I 
give you the report as it was taken at hospital by 
myself and the doctor in charge. I assisted in the 
autopsy. 

Bilious Fever. — Mr. P. Pulse 108 ; tongue 
foul ; pain in back, legs and head ; stomach tender 
and nausea ; eyes slightly yellow ; urine scanty ; 
bowels open. I regret that I have not the tempera- 
ture in either case, but the above report will show 
a similarity in the two affections, but also a slight 
difference between the yellow fever case quoted 
and the rest, in general. The bilious case re- 
covered, and it was not so bad as the other one. 
We used various remedies at the hospital, and lost 
about one-fourth of the patients. 

In Florida the higher lands seem to be more 
subject to fever than the lower ; wet places more 
free than the dry lands, where the sun soon dries 
the ground and enables the microcosm to float in 
the air. I don't see why one place may not have 
pure air and the one next foul air ; that one may 
be sick in one room, from bad air, and the next 
person in an adjoining room be free, where pure 
air may abound. As in a case of carbonic acid 
poisoning. Again, in some parts of Florida the 
water they drink seems to be poisonous ; to favor 
sickness ; so we may see that both air and water 
may convey a poison. At this place the water is 
good, yet we have fever, which I think is from 
air poisoning, while in Marion county the water 
is bad, and may seem to cause sickness. 

As to contagion, I agree with Surgeon Woodworth. 
I don't believe in it, though I think the germs may 
be carried by fomites, and not capable of self- 
multiplication in the human body. In reply to 
Dr. Nowlin, I would say that it may not depend 
upon the increase of germs in the body as to 
whether the disease is violent or not, but on the 
amount of poison one takes into the systepa, as in 
intermittent and remittent fever. I think the 
greater the amount taken into the system the 
greater the violence of the attack. The bed 
clothes may become infected, not from the body, 
but by the heat and filth which must of necessity 
be generated by reason of the close confinement of 
the patient to bed, allowing no air to reach the 
body, nor can the sick person be washed thorough- 
ly. All this must tend to the development of 
germs, not from the person, but on account of 
favorable conditions being present for harboring 
poison when present in air ; :heat and filth condi- 
tions favorable for propagation of disease when 
the poison is present ; therefore, may the germs be 



42 



Correspondence. 



[Vol. 



carried by fomites to places unhealthy and 
filthy, and produce an epidemic. And why not 
the fever germs travel in air from place to place, 
as do the locusts (fasten upon all green things), 
wherever they a fit place find. If the fever was 
communicable from person to person, why did not 
I, who devoted time to fever wards, take the "con- 
tagion ?" I helped give baths and medicines, and 
paid particular attention to the fever patients ; or 
the nurse who was among them constantly, an 
Englishman, too ! (I say Englishman, because 
it is supposed that strangers, or those from higher 
climes, are more liable than those to " the manor 
born.") I did not stay in Savannah at night; I 
went into the city, from a pure atmosphere, drank 
of the water in town. I say, if it had been con- 
tagious, why did we not take the yellow fever ? I 
don't believe in contagion, but do in infection, 
and agree with Dr. Lynch in his views, and would 
advise having quarantine, by all means ; th€ exclu- 
sion of fomites from a city, and strict attention to 
the sanitary conditions of a city. 

Kespectfully, J. G. BuiiLOCH, m.d. 

Morrison's Mills, Fla. 



Pathology of Hysterical Cough. 
Ed. Med. and Surg. Eeporter : — 

An article in No. 25, volume xxxix, on " The 
Importance of Medical Observation in Rural 
Districts," has encouraged me to reply to an 
article in No. 20, same volume, by Dr. Eisel, of 
Messeburg, on "The Management of Hysteria." 
In reference to the treatment of the case quoted, 
where he chloroforms a patient for fourteen days, to 
quell a " violent cough," hysterical or nervous in 
character, I shall not enter into any discussion 
of the cause of such symptoms, whether they 
originate from genital disturbances or not, but will 
quote three cases, and leave you to judge whether 
his theory and practice are the best or not. Though 
coming from a learned professor and a foreign 
land, I believe he misses the mark very widely. 

Case 1. — Mrs. J. S., aged thirty-four, hysterical, 
suffering from uterine polypus, was taken with 
violent cough, and for ten days I could get nothing 
to alleviate it a particle ; finally, in examining the 
spine, I discovered that pressing on the fourth 
and fifth dorsal vertebra increased the cough. I 
ordered a blister to the spot, which remained twelve 
hours, and the cough vanished completely. I 
subsequently got rid of the polypus, and the patient 
has since borne a thirteen and a half pound child, 
and has good health. 

Case 2. — Mrs. S. A. T., aged twenty-two, hys- 
terical I had procured an abortion with her, for 
relief of puerperal convulsions, on January 24th, 
1877. She remained in delicate health, but became 
enceinte in August. I was called October 1st, 
and found her emaciated ; had retained no food for a 
week, and in the last two days retained nothing, not 
even a spoonful of water ,• the spine was excessively 
tender, and pressure on the lower dorsal vertebra 
caused retching. Ordered bis. sub. nit. et ingluvin, 
equal parts, five grains every three hours, and a 
blister to the spine. She vomited everything until 
the blister had done its work ; then she retained the 
medicine, and in a short time was able to take a 
light diet. October 3d. Some cough ; retains 
food. October 4th. Cough violent, and continued 



so for three days, interfering with the digestion. 
October 8th. Find some vomiting; cough still 
violent, and excited by pressure on the dorsal 
vertebra; applied blister to the spine, and it 
remained twenty-four hours without blistering, over 
the third, fourth and fifth dorsal vertebra. October 
9th. Still coughing ; applied a fresh blister where 
the other failed, and in ten hours it blistered, and 
in twenty-four hours the cough was gone. She 
recovered, and in May, 1878, was delivered of a 
fine child, at full term. 

Case 3. — Mrs. A., has uterine trouble of long 
standing. Was called November 17th, 1878, and 
found she had diphtheria, which ran a severe 
course. The fifth day of the disease had slight 
cough ; was fearful of extension of disease into the 
larynx, but all remedies for it failed to even check 
its progress. On the decline of the diphtheria, in 
the third week, the cough still increasing, I ex- 
amined the spine and found that there was cough 
on pressing the dorsal vertebra; applied the 
blister, and when it produced sufficient counter- 
irritation the cough subsided. 

My conclusions are, that a nervous or hysterical 
cough comes originally from genital disturbances, 
through the spine, and my treatment is satisfactory 
to me and my patients. W. S. Dodd, m.d. 

Amity, Pa. 



Remarks on a Case of Puerperal Convulsions. 

Ed. Med. and Surg-. Eeporter : — 

On Nov. 14th was called to see Miss D., single, 
aged fifteen years, primipara. Found patient in 
severe puerperal convulsions; was informed by 
friends that she was in that condition when first 
noticed, about 4 o'clock in the morning, and her 
prostration and the terribly lacerated condition of 
tongue and lips indicated that she might have been 
in convulsions the greater part of the night. She 
had complained of severe headache and dizziness 
the evening previous. From the time found until 
my arrival, 9 a.m., her convulsions were severe, 
with but slight intermissions. I controlled the con- 
vulsions with chloroform, made an examination, and 
found the os pretty well dilated ; membranes rup- 
tured, but the pains were not very severe. I dis- 
patched a messenger to my office, eight miles dis- 
tant, for more chloroform, having only half an 
ounce, hydrate of chloral, and my forceps. The 
messenger who came for me was a small boy, and 
I knew nothing of the nature of the case, and was 
poorly prepared for such an emergency. Gave 
bromide potass., in full doses. The convulsions 
increasing in severity, and the prostration momen- 
tarily increasing, fearing the patient would die 
before the messenger arrived with forceps and 
chloroform, and thinking it would give the woman 
one more chance for her life (the child being 
already dead), I determined to deliver by podalic 
version ; this I succeeded in doing after some time, 
the process being necessarily a slow one, owing to 
severity of convulsions and almost continuous uter- 
ine pain excited by presence of hand, and for lack of 
chloroform to control convulsions. Placenta and 
membranes followed immediately, and considerable 
hemorrhage. Secured uterine contraction. Gave 
small dose bromide potass. Convulsions ceased, but 
patient remained in a comatose state, stertorous 
breathing, and vomited once the peculiar coffee 



Jan. 1 1, 1879 ] 



News and Miscellany, 



43 



ground vomit, so indicative of great prostration. 
Notwithstanding external heat, stimulants, etc., in 
two hours the convulsions returned, and two 
hours later patient died. Notwithstanding the 
tediousness of the version, she was delivered two 
hours before the forceps arrived, and undoubtedly 
a still longer time must have elapsed ere nature 
alone would have accomplished the work. Much 
more time might have been saved had I had my 
forceps with me. 

Now, was the course pursued the best, under the 
circumstances above detailed? Editor please 
answer. J. A. Eawls, m.d. 

Macksburg, Iowa. 



A Case of Scrofula. 
Ed. Med. and Surg. Eeportee : — 

Dec. 4th, 1878, I was called to see K. Z., age 
sixteen months. On looking at the little patient, 
I saw, from the swollen neck and cheek, that she 
was laboring under scrofula. She had been treated 
four days previous by another physician, but 
without any benefit. Pulse 150, temperature 105° ; 
had a chill the evening before I was called. I 
ordered flaxseed poultices to the neck, and gave 
her five-drop doses of syrup of iodide of iron, in 
water, three times a day, also quinine, to break 
up the malarial trouble, and Dover's powders, to 
keep her quiet. Saw her again at eight next 
morning ; she had rested very well ; pulse 120, tem- 
perature 100° ; treatment continued. Saw her at 
ten next morning ; had not rested very well ; she 
was crying and fretting a good deal ; pulse 125, 
temperature 120J° ; treatment continued ; bowels 
moved with castor oil. Saw her again at nine 
next morning ; very restless ; pulse 115, temperature 
100° ; abscess pointing on the neck, , which was 
evacuated by the lance ; treatmqjit continued. Saw 
her again next morning ; found her considerably 
better. Saw her again next morning and dis- 
charged the case. Wm. F. Hameb, m.d. 

Mitchell, Ind. 



A Case of Trephining 
Ed. Med. and Surg. Eeporter : — 

On June 11th, 1877, I was called, in consultation 
with Drs. Reed and Bennett, of Iberia, Ohio, to 
see a. little son of Geo. Yaker. The boy, aged 
seven, while playing in the yard, received a 
kick from a horse, crushing the skull at the pos- 
terior and upper border of the left parietal bone, 
at the junction of its articulation with its fellow 
and the occipital. The accident happened about 
six o'clock in the evening, and I saw the case first 
at 9 o'clock P.M. same day. He was then, and 
had been from the time of the accident, in a coma- 
tose condition. After making a careful examination, 
thought best to operate at once. 

By the light of two oil lamps proceeded to 
operate by enlarging the scalp wound, and then 
proceeded to trephine. After removing the button 
was able to remove two large and one small piece 
of bone. The larger ones were respectively If by 2^ 
and l}i by 1 inch diameter. Was very fortunate in 
not rupturing the dura mater. Partially closed 
the wound, leaving an opening for drainage ; or- 
dered patient to be placed in a dark room, exclud- 
ing all persons but regular attendant; that he 



should be kept well over on his left side. Ice 
should be applied to wound, and that it should be 
cleansed with carbolized water. Ordered veratum 
and aconite, to control circulation ; bromide of 
potass., to produce rest. He was given good diet, 
and quinine and iron. The cold was kept on the 
head for nearly two weeks ; he was kept in the 
dark room three weeks. 

His recovery was complete, being able to be 
around in six or seven weeks. 

There are several interesting features in the 
case, principal of which is the time of operating, 
position and seat of fracture, and his complete 
recovery. H. E. Kelly, m.d. 

Gallon, Ohio. 



News and Miscellany. 



New York Academy of Medicine. 

At the annual meeting of the New York 
Academy of Medicine the following oflicers were 
elected : Fordyce Barker, m.d., ll.d., President ; 
William T. White, m.d., T. Gaillard Thomas, m.d., 
James R. Leaming, m.d., Vice-Presidents; John 
G. Adams, m.d.. Corresponding Secretary ; Horace 
T. Hanks, m.d.. Recording Secretary ; Edwin F. 
Ward, M.D., Assistant Secretary; Francis V. 
White, M.D., Statistical Secretary ; Horace P. 
Farnham, m.d.. Treasurer; Austin Flint, m.d., 
Samuel T. Hubbard, m.d., Isaac E. Taylor, m.d., 
S. S. Purple, M.D., Trustees. 



Vital Statistics of New York City in 1878. 

From the return of the Health Board of New 
York it appears that in 1878 the greatest number 
of deaths from any one disease was phthisis, and 
the next most destructive disease was diarrhoea. 
The deaths from small-pox were two only, the 
number being the smallest reported for any year 
since 1824. This small mortality is attributed to 
the activity of the Vaccinating Corps for several 
years past. It is believed by President Chandler 
that this good result is an indication, not to be 
questioned, of the efficiency of vaccination, and of 
the great importance of maintaining the strength 
of the corps. 

The number of deaths in 1878, as compq,red 
with that of 1877, is given in the following table, 
the diseases being given by general classification : 

Classes of Disease. 1878. 1877. 

Total deaths from all causes 27,005 26,203 

Total zymotic diseases 7,635 8,042 

Total constitutional diseases 6,422 5,800 

Total local diseases 10,197 9,720 

Total developmental diseases 1,709 1,615 

The deaths from diphtheria and scarlet fever are 
but slightly greater in number in 1878 than in 
1877. The returns by wards show that the ward 
in which these two diseases have prevailed to the 
greatest extent was the Nineteenth. The Fifteenth 
ward has enjoyed almost complete immunity from 
the ravages of both scarlatina and diphtheria. 
While the theory that sewer gas has caused diph- 
theria has been abandoned, and it has been found 
impossible to demonstrate that the diseases have 
clung to the lines marked by original water 
courses, there has been abundant evidence that 



44- 



News and Miscellany. 



I Vol. xl. 



both of these diseases have been aggravated by 
sewer gas and bad drainage. 

It is of interest to know that but one mother 
bore trii^lets dui-ing the year, while 206 mothers 
gave birth to twins. One mother of fourteen gave 
birth to a child, 2 mothers of fifteen gave birth to 
their second children, and 442 mothers over fifty 
bore children. 

During the year there were born dead 2292 
infants. The Coroners had, of all classes of cases, 
2970. The number of transcripts of records of 
births issued was 200 ; of marriages, 188, and of 
deaths 1160. The record contains the names of 
15 persons whose age at the time of their death 
was said to be 100 years or more. Of this number 
but three were men, and all but three of the 
alleged centenarians were born in Ireland. 



Obituary Notices. 

— Dr. William K. Scott, an old resident and 
widely -known citizen of Buffalo, died January 5th, 
aged ninety-one years. He was a graduate of 
Dartmouth College, and afterward attended lec- 
tures in New York with the late Valentine Mott, 
and was the first physician licensed by the Censors 
of the State of New York, being nineteen years of 
age at that time. 

— Dr. S. T. Brooks was found dead in his room 
at Greenville, 111., on the morning of the 3d inst., 
with one hand roasted and a large hole burned in 
the floor. Appearances indicated the explosion of 
his lamp, but the fire had gone out, evidently for 
the want of air. The Doctor had numerous friends 
and relatives at the East. 

— Dr. John Bonner died at the residence of his 
son, Dr. J. I. Bonner, in Fairfield, Texas, on the 
morning of the 14th of November, 1878, aged 
eighty-live years. Dr. Bonner had long retired 
from professional life, but during his prime was 
distinguished as a surgeon and physician. He 
was the last of his generation, leaving neither 
father nor mother, brother nor sister. 

— Dr. Frederic Quin, who recently died in 
London, was one of the most agreeable of racon- 
teurs and '' consummate diners-out " whom London 
has seen since Mr. Canning. He was of Irish 
parents, but educated at the Edinburgh school of 
medicine. He inherited that sarcastic and appar- 
ently unconscious wit which is characteristic of 
his countrymen. Dr. Quin's bright, winning 
manners early marked him for advancement, and 
he was, when very young, selected as traveling 
physician to Prince Leopold, afterward King of 
the Belgians, and subsequently was named by 
Lord Liverpool to succeed Mr. Harry O'Meara as 
medical adviser to Napoleon, who was fretting out 
his life at St. Helena. But the news of the death 
of the fallen Emperor, on the 5th of May, 1821; 
on the very eve of his departure, frustrated this 
purpose. However, he had improved every op- 
portunity offered him; and he was some time after 
appointed physician in ordinary to the Duchess 
of Cambridge. This office familiarized him with 
royalty, and he became the cherished friend of the 
present Duke of Cambridge and of the Prince of 
Wales. No dinner at the Duke's chambers in St. 
James' Palace, or a party at Sandrigham, was 
Complete without "the Doctor's presence." His 



cheery manner and gifts as a raconteur made him 
a special favorite with the young. Dr. Quin was 
over eighty when he found a tranquil close to his 
pleasant life, at his chambers, at Queen Anne's 
Mansion. In London society his well-known face, 
form and figure will long: be missed. 



Statistics of Providence. 

Dr. E. M. Snow says, in his last Report of the 
City of Providence — 

the total mortality of the year 1878 was 1988, 
which is at the rate of 19.88 in each 1000 of the 
population. In 1877 there were 1938 deaths in 
Providence ; in 1876 there were 1862 ; in 1875 the 
number was 1915 ; and in 1874 there were 1987 
deaths, or almost exactly the same number as in 
1878. 

Diphtheria still continues quite prevalent in the 
city, though there is a decided decrease in the. 
number of cases and in the mortality from the 
disease. The number of deaths in December, from 
diphtheria, was 8 less than in November. 

Scarlatina is prevalent, though generally in a 
mild form. This disease will probably increase 
until spring, while diphtheria will decrease. 



Besolntions of Eespect. 

The following resolutions were passed at the 
last meeting of the Abingdon (Ya.) Academy of 
Medicine : — 

Whereas, It has pleased the Great Physician 
of the Universe to remove from this world, the 
field of his usefulness, our highly esteemed and 
worthy friend, Washington L. Atl.ee, m.d., of 
Philadelphia, Pa., an Honorary Fellow of the 
Abingdon Academy of Medicine, 

Resolved, That it is with deep and unfeigned 
regret that we clm)nicle his death — for the world 
has lost one of its greatest and best medical and 
surgical philosophers, teachers and practitioners ; 
the city in which he lived one of its best citizens ; 
the medical profession one of its most faithful and 
laborious members ; this Academy of Medicine 
one of its most prominent and highly esteemed 
Fellows ; and his family its noble, kind and affec- 
tionate head. 

Resolved, That we tender the bereaved family of 
the deceased our sincere condolence and heartfelt 
sympathy in the hour of their great affliction. 
W. F. Bare, m.d., 
Geo. E. Wiley, m.d., 
H. M. Grant, m.d., 
Committee. 

Abingdon, Va., Bee. 2d, 1878. 

MABBIAGES. 

Peterson— Cobb.— At Zion Church, Dec. 30th, 
1878, by the Rev. J. N. Galleher, d.d., assisted by the 
Rev. William Staunton, d.d., Dr. Wilson Peterson 
and Emmeline F., daughter of the late Carlos Cobb, 
all of New York. 



DEATHS. 

Julian.— At Hoboken, N. J., Jan. 1st, 1879, John 
M. Julian, m.d., in the 68th year of his age. 

Vedder.— On Sunday, Dec. 29th, 1878, at the resi- 
dence of his brother, Dr. Maus K. Vedder, No. 135 
East 57lh St., Alexander M. Vedder, m.d., of Sche- 
nectady, N. Y., aged 65. 






WHOLE No. 1142.] 



JANUARY 18, 1879. 



[VOL. XL, No. 3. "^^^^4 



THE 



^^MEDICAL AND SURGICAL 
lEEFORTEIRs 

A ^WEEKLY JOTJR]SrA.I., 

EDITED BY D. G. BRINTON M. D. 



Terms of Sulbscriptioii, FIVE DOLLARS per anuiim, in advance.— Single Copies Ten Cents. 



OOJNT3EIVTS 
ORIGINAL DEPARTMENT. 



:COMMUNICATIONS. 



Brief Hints on the Progress of Otology, lor 1878... 45 

Corson, Hiram.— Tiioughts on Midwifery, No. 2 49 
^ HiNKLE, Fkanklin.— Case of Extra-Uterine 

Pregn ancy 5^ 



HOSPITAL REPORTS. 

L Pliiladelphia Hospital— Clinic of .Dr. John H. 
H. Brinton— Sprains ; Erysipelas 53 

MEDICAL SOCIETIES. 

The Rhode Island State Medical Society— Diph- 
theria 56 



EDITORIAL DEPARTMENT. 

PERISCOPE. 

Digitalis in Heart Disease 57 

Thoracentesis in Phthisis 57 

Conclusions Reganiing Dipsomauia 58 

Conditions Necessary for Contagion to Spread.. 58 

Idiopathic Gangrene of the Penis 58 

REVIEWS AND BOOK NOTICES. 

Notes on Current Medical Literature 59 



BOOK NOTICES. 

Modern Medical Therapeutics; a Compendium 
Of Recent Formulse and Specific Therapeutical 
Directions (Naphey s) 



editorial. 

The Grounds of Certainty in Medical 
Reasoning 



notes and comments. 

Potato Eating and Diphtheria 

Peculiarities of Inebriety 

The Forms of Antagonism in Drugs 

E( zema Produced by Oxyurides 

The Species of Tapeworm Now Prevalent 

Suicide and Insanity 

Hints for Headaches 

Effects of Chronic Starvation on the Mind 

Chloral in Migraine 

Influence of Uterine Disease on Nervous Dis- 
orders 

The Physiology of an Easy Chair 

The Best Forin of Mercury for Hypodermic Use. 

The Causes of Heat in Fever 

Oleate of Zinc 



CORRESPONDENCE. 



The Cause of Yellow Fever (McClanchard). 
Acetate of Potas&a (Henning) 



NEWS AND MISCELLANY. 

State Medicine in Pennsylvania 

Extracts from ihe Bulletin of the Public Health, 
Issued by the Surgeon General United States 
Marine Hospital Service, for Week ended Jan- 
uary 4th, 1879 

The " Index Medicus." 

Investigation of the Yellow Fever 

Personal 

Obituary Notes 

Marriages and Deaths. 



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I\ii 



THE 



MEDICAL AND SURGICAL REPORTER. 



No. 1142.] 



PHILADELPHIA, JAN. 18, 1879. 



[Vol. XL.— No. 3. 



Original Department, 



Communications. 

beief hints on the progkess of 
otology, for 1878. 

The progress made in our knowledge of diseases 
of the ear, their pathology and treatment, has 
during the past year been decided and of value, 
both to the specialist and general practitioner. 

Besides the two foreign journals* devoted ex- 
clusively to otology there is one published simul- 
taneously in Germany and this country f, and still 
another one has been announced in New York. 
One new volume on the diseases of the ear in general 
has been issued in Philadelphia, and a new edition 
also of a similar older work has been republished 
in New York. All this amount of special litera- 
ture would go to show a demand for a more perfect 
acquaintance with this important subject by the 
general practitioner. I shall not enter minutely 
into the subject, lest detail tire the general reader 
as well as monopolize too much valuable space in 
your journal, but I shall be content to jot down 
and criticise a few points of special interest and 
practical importance. 

1st. " A Case of Cleft Palate with Acquired Deaf 
muteism. Staphyloraphy, with Recovery. By Dr. 
A. D. Alt, M. c. p., of Toronto.t This case is both 
interesting and instructive ; first, owing to the ex- 
treme youth of the patient operated upon — he 
was only seven — and second, the great improvement 
of the patient's speech. By the operation the 
Eustachian orifices were protected against the 

*Archiv ^iir Ohrenheilkunde, and Monatsschrift 
fiir Ohrenheilkunde. 

t Arch. Ophthalmology and Otology, Wood & Co., 
New York. 

t Vol. VI, Nos. iji and iv, p. 569. 

45 



relapses of middle ear inflammation which are so 
apt to follow from the entrance of obnoxious sub- 
stances through the mouth and Eustachian tube. 
Great improvement followed the local treatment 
of the ears (patient had otitis media purulenta, 
with perforation of the left membrana tympani). 

The tonsils and pharynx were hypersemic, and 
there existed the same condition of the mucous 
membrane of the nose, especially around the ori- 
fices of the Eustachian tubes. Prior to the opera- 
tion and treatment of the local difficulty the 
watch of the operator (which was heard at a 
normal distance of 20^) was heard at two inches 
on the right, and on the left side, only when 
pressed against the ear. While the boy under- 
stood his mother by watching her lips attentively, 
he could not understand the doctor at all. The 
first operation was performed on the 25th of Sep- 
tember 1877, and a second, on the uvula, which 
had cut through, on the 23d of October. On the 
15th of December the doctor discharged him, cured. 

On the 28th of January, 1878, the following was 
his report : Medium loud voice heard in left side 
at 25'', right 20^ ; " the boy now hears and speaks 
well enough to go to school and do all the errands 
for his mother." 

I would in this connection make but one obser- 
vation, arid caution those about performing this 
operation, i.e., staphyloraphy. A close study 
should be made of the pharynx. Eustachian tubes 
and their muscles, that they may not be disturbed, 
for we must do more than simply unite the cleft, 
and employ local treatment, which in most cases 
is absolutely necessary. A clear idea of the topo- 
graphical anatomy of the parts should be had, so 
that in the operation we may carefully avoid 
injuring the muscle of the Eustachian tube. It has 
fallen to our lot to meet with such a case in an 



46 



Communications. 



[Vol. xl. 



adult, where the surgeon, by his operation, almost 
completely closed the Eustachian tube of one side 
(where there existed a purulent otitis media with 
perforation), and it was only by powerful inflation 
that any air could be made to reach the middle ear 
and the hearing be thus improved. 

The subject of testing the hearing of deaf per- 
sons is one of much importance to the physician 
who would make a successful diagnosis. The 
ordinary means at our command are the voice, 
watch, tuning-fork, and rods of Koenig. The dis- 
advantage of the voice is, that in slight degrees of 
deafness, it is of little value, while the watch has 
but two variable tones, and the intensity of these 
tones is very slight, and the patient's estimate of 
the hearing is with difficulty controlled. The ob- 
jection to the tuning-fork as an exact test of hear- 
ing is, that the intensity of the tone is not deter- 
mined, as we are not always able to strike a tuning 
fork with the same force. Tuning-forks, like 
watches, vary, both in pitch and intensity. Pro- 
fessor Politzer has undertaken the construction of 
a uniform acoumeter, which has been tested, 
and is ihus described by an accurate and accom- 
plished aurist, Dr. Arthur Hartmann, of Berlin, in 
a paper on " Hearing Tests and Politzer's Uniform 
Acoumeter."* 

Dr. Hartmann states that " as the measurement 
of the sensibility of a nerve must be an impulse of 
determined intensity, we must employ, for determi- 
nation of the perceptive power of the auditory 
nerve, tones of a given intensity." Careful ex- 
periments in this direction were made by " Schal- 
hanel," who made use of a ball falling from a 
certain height, as a sound source. " Itard " in- 
vented a pendulum acoumeter, which consisted of a 
freely suspended copper ring, against which a 
pendulum with a metal ball strikes. The eleva- 
tion of the pendulum could be measured on a 
graduated circle, and the intensity of the tone be 
thereby determined. "Wolke," a German, em- 
ployed as a sound source an upright sounding 
board of fire wood, against which a mallet of oak 
wood was allowed to fall through a given space. 
Various other instruments have been constructed 
to test the perception for tones of different pitch. 
Most of these instruments are too complicated and 
impractical to come into general use. 

Politzer having undertaken the construction of 
a uniform acoumeter, has found such an instru- 
;ment must possess, as will be seen from what is 
above said, the following qualities: — 

1. " The construction must be more simple and 

• "Archives of Ophthalmology and Otology," p. 
603 opt cit. 



the manipulation less complicated than in former 
acoumeters. 

2. " The intensity and pitch must be accurately 
determined, and the instrument must serve as a 
test as well for aerial as for bone conduction." 

Politzer's acoumeter " consists of a steel cylinder, 
four millimeters in diameter and twenty-eight 
millimeters long, set in vibration by the blow of a 
small hammer, also of steel. The cylinder is 
fastened vertically to a small column of vulcanite, 
the hammer being freely suspended from a slot in 
this column by means of a pin. The lever of the 
hammer projecting behind and beyond, the vul- 
canite column can be depressed to a certain point, 
and then liberated allows the hammer to strike 
the cylinder from a certain height, thereby in- 
suring a certain intensity of tone. Two half rings 
being fastened at either end of the vulcanite 
column, the instrument may be held between 
the thumb and forefinger, the middle finger being 
free to set the hammer in motion. A small disk 
is also fastened to the vulcanite column by means 
of a pin, and is used for testing perception for 
bone conduction. The whole instrument is so 
compact that it may easily be carried in the vest 
pocket, and its construction is so simple that it can 
hardly get out of repair." The price is five and a 
half florins, Austrian currency.* 

The Politzer instrument has met, in the first 
degree, the demands previously given. Those 
who demand of an acoumeter that it should in- 
clude a larger number of tones will not be satis- 
fied with it. The principal value of an acoumeter 
is to be found, not in the means of determining 
the perceptive power as a whole, but in detecting 
slight changes which may occur from time to time, 
under varying circumstances, or as a result of 
treatment. 

In our knowledge of "Mastoid Disease" pro- 
gress has been made by the investigations of Dr. 
Arthur Hartmann,! of Berlin, with the results of 
numerous operations on the cadaver ; an abstract is 
here given also.J Three rare cases are reported 
by Dr. L. Turnbull, two successful and one post- 
mortem. In the first case it appears the Doctor, 
even in his early cases, which he reported in 1862, 
had acted on the same plan recommended by Dr. 
Hartmann. In the table published by " Burnett," 
see p. 545, opt. cit., he omits all the cases from 1862 
to 1864, but a more complete and perfect account 

♦ Optician Gottlieb, 12 Adlergasse, Vienna, 
t Ueber die Perforation des Warz^rifortsatzes 
von Dr. Arthur Hartmann, in Berlin, Separat-Ab- 
d *uck, aus v. Langenbeck's Archiv, Bd. xxi, Heft ii. 
X Transactions of Med. Society, State of Pennsyl- 
vania, vol. xii. Part 1, Collins, Phil., 1878. 



Jan. 1 8, 1 879. J 



Communications. 



47 



will be found given by " Schwartze and Eysell," 
Archiv f. Ohrenh. Bd, 1, N. F., 1873. The same 
omission is made by Eoosa in his fourth edition, 
and neither of these gentlemen, in their works, 
refer to Hartmann's investigations. A valuable 
monograph has been published by Dr. C. Miot, of 
Paris* (a gentleman who is well known by his con- 
tributions to the subject of otology), on " Tenotomy 
of the Tensor Tympani Muscle," and his conclu- 
sions on p. 41 are very favorable to the operation 
in relieving aural vertigo, tinnitis aurium, also 
certain forms of nervous deafness. The author 
gives a historical sketch, in which he gives due 
credit to Hyrtl, in 1874, as being the first who 
suggested the operation, and performed it in 1868. 
Then follows the numerous and careful operations 
of " Weber-Liel," of Berlin, Gruber and Franks, 
of Vienna, and he fails not to do justice to Ameri- 
can operators. Dr. White, of Baltimore, Professor 
Calhoun, of Atlanta, Georgia, and Doctor Turn- 
bull, of Philadelphia. 

On April 27th, 1878, Dr. Laurence Turnbull 
delivered, before the class of Jeiierson Medical 
College Hospital, a useful clinical lecture on 
" Congenital and Acquired Defects of the External 
Ear,"f Exostoses of Meatus, concluding by a de- 
scription of a frequent but not well recognized dis- 
ease, Desquamative Inflammation of the Auditory 
Meatus, and following " Wendt's " admirable de- 
scription of its extension into the tympanum and 
mastoid. 
K A subject of special interest is that of " vertigo," 
i^ which has been recently investigated by Dr. 
Woakes.J The phenomenon of labyrinthine ver- 
tigo, the one we are most interested in, an irri- 
tation of the inferior cervical ganglion, is due to 
disordered circulation in the labyrinth through 
the vaso-motor nerves of the vertebral artery. The 
labyrinth of the ear is supplied entirely from the 
vertebral artery, and discharges its veins into the 
superior petrosal sinus while the tympanum is 
supplied by branches of the carotid artery, and 
discharges its veins into the internal jugular. 
The bromide of potassium, sodium, calcium, and 
hydrobromic acid, as well as the hydrobromic 
ether, have the power of diminishing this vascular 
innervation and reducing the calibre of the ves- 
sels and the flow of blood. Dr. Woakes narrates 

• De la T6notomie du Muscle Tenseur du Tym^ 
pan. Par Le Dr. C. Miot, Professor of Otology, 
etc., etc. Avec 11 Figures dans Je Textp. v. A. 
D«lahaye et Cie, 2;^ Place de L'Ecole do M6decine. 
Paris, 1878, pp. 54. 

t MEOICAIi AND SUBGICAIi REPORTER, April 27th, 

1878 (Philadelphia, D. G. Brinton, 115 S. Seventh 
Street), p. 327, No. 1101. Vol. xxxviii. No. 17. 

XLancet, Feb. 9th, 1878. British Medical Journal, 
March, 1878. 



several cases where the internal administration of 
hydrobromic acid has produced favorable results. 
In our experiments we can corroborate these good 
results, also the good effects of the hydrobomic 
ether,* both as a local and general anaesthetic, as 
well as in relieving those distressing subjective 
noises. These means should be employed to re- 
lieve the patient from the noises and deafness in 
connection with local treatment of the ears, which 
are very rarely free from some accompanying dis- 
ease associated with the tinnitus aurium. 

In the treatment of otorrhoea. Professor 
Gruber, of Vienna,f suggests some new methods 
of applying old remedies. In narrowing of 
the meatus he recommends pledgets of charpie, 
or bougies of laminaria smeared with simple oint- 
ment. In otorrhoea from inflamed drum membrane, 
he has employed an artificial membrane of linen 
applied to the inflamed membrane, covering 
the linen with ointments of oxide of zinc, red oxide 
of mercury, etc., in varying proportions ; also, in 
cases of exudation and swollen tympanic mucous 
membrane, he employs " Hart's" gelatine globules 
or wafers, prepared, as they now are, with sulphate 
of zinc, tannic acid, biborate of soda, carbolic acid, 
and nitrate of silver, in the varying proportions of 
from 1-10 in 100. 

The subject of "Diseases of the Ear from 
Bathing" was first prominently brought before thd 
profession at the International Medical Congress,, 
by Dr. L. Turnbull, of Philadelphia, and a paper was 
read by him showing its importance, which, after 
an animated discussion, was approved of, and the 
discussion and paper were referred for publication. 
Only the paper was published, which was unfortu- 
nate, as much valuable experience was thus lost ; 
but we are happy to state that Dr. Samuel Sexton, J 
of New York, took the subject up, and in a most 
thorough and complete manner has given the 
results in full to the profession. He shows the 
frequency of aural disease from bathing, both in 
salt and fresh water ; how the ear is attacked, 
treatment, etc. 

The same authority^ reports a clinical lecture 
on "Accumulations which Obstruct the External 
Auditory Meatus," with the etiology, character of 
the accumulations, duration ; also the symptoms 
producing irritation of the nervous apparatus of 
hearing, etc., with many new and interesting facts 

*T aus. Med. Soc, State of Pennsylvania 1878. 

t AUgemeine Wiener Med. Zeitung, Nos. 1 and 2, 
1878. 

X The Medical Record, vol. 13, No. 118. New York, 
May, 1878. Wm. Wood & Co. 

I Practical Otology. Being a clinical lecture de- 
livered at the New York Ear Dispensay, by Sani 
uel Sexton, m.d. Medicd Record, vol. xiv. No. 7. 
New York. August 17th, 1878. 



4S 



Communications. 



|Vol. xl. 



in reference to an old, dry subject. It is some- 
times difficult to introduce fluids charged with 
medicated remedies, and to overcome this, Dr. 
James Keene,* Aural Surgeon to Westminster 
Hospital, etc., has invented an instrument for an im- 
proved method of introducing fluid remedies into 
the tympanum, and published a small pamphlet, 
and has kindly sent one to the writer. As, how- 
ever, our difficulty has been more in the introduc- 
tion of the Eustachian catheter, not the fluid, on 
account of broken noses, etc., we cannot enter 
into the doctor's feelings, but will describe his 
instrument, which he illustrates by a drawing. 
It is a small vulcanite syringe, made to contain 
about fifteen minims of fluid ; it has a capillary 
gold tube, through which the contents of the 
syringe are conveyed to the catheter, this is con- 
nected to an adapter which has an opening into 
the catheter and one downward into the fluid, like 
a spray arrangement ; a tube enters the inflating 
arrangement to this lower opening, and a current 
of air in its passage over the end of this capillary 
gradually exhausts the fluid contents of the 
syringe, which are converted into spray before 
entering the tympanum. I have also received 
two practical pamphlets from Dr. Arthur Hart- 
mann, of Berlin, two brief extracts from which I 
have only space to call to the attention of those in- 
terested in the subject, which have been translated 
and published in the journals.f 

"The Treatment of Chronic Aural Discharges." J 
This subject I have already referred to, by 
"Gruber." In the pamphlet before us, of ten 
pages, taken up with matters well known (or should 
be) by the profession, washing out the ear with 
care, etc., the result arrived at in the Doctor's 
experiments is the discarding of his old remedy, 
salicylic acid and chalk, which a gentleman of 
Washington, D. C, improved by substituting starch, 
instead of the insoluble chalk mixture, with the 
acid. Now, Dr. Chisholm has founded all his 
hopes on the oldest remedy known for otorrhoea, 
namely, alum, discarded long ago by the aural 
surgeon, because it produced abscesses in the ear. 
In his practice he states he has ceased to consider: 
chronic aural discharges an obstinate disease ; for, 
under thorough cleansing and the insufflation with 
alum or tannin, he finds they yield more kindly to 
treatment than any other bodily aflection that has 
been of long continuance. Now, the best and 
most reliable authorities state that chronic otorrhoea 

*Hardwlck & Bouge, 192 Piccadilly, London, 1878 
t Bei.trag zur Lehre von der Ozaua. Schwelr- 

horigkeit bei Kindern verursacht durch chrones- 

chen Naseurachenc \tarrh, Berlin, 1878. 
X Dr. Chisholm, Baltimore, Md. 



is one of the most tedious affections they have to 
treat, no matter how careful or with what remedy 
they are treated, and it often requires months 
of treatment with various remedies. 

The success of a special work* does not always 
depend upon its merits; it often depends on its 
author being a professor in a medical school ; or 
on the bookseller, who is active and energetic, 
pushing his books into every available market, 
perhaps owning a journal, and watching with care 
the reviews of the work, that is placed in the 
hands of those who not only will do the book full 
justice, but overlook even mistakes and grave 
inaccuracies, so as to receive like favors for them- 
selves ; therefore, when a reviewer is called upon 
to review a work in its fourth edition (no matter 
how many the editions are in number), it is diffi- 
cult to do it justice ; still it is necessary, for the in- 
formation of the general profession, that this should 
be done, else the review is of no benefit to them. 

Now, the work before us is an electrotyped 
work, which is an objection to it, as changes are 
difficult and expensive to make ; and when we 
compare it with the first edition, we find, with a 
very few exceptions of cutting out a little and 
adding a little here and there, that the work is the 
same as the first edition, except that portion on 
Diseases of the Internal Ear. To show that the 
author has not even gone carefully over it, as he 
should have done, we would refer to the prescrip- 
tion on page 305, where iodine is directed to be 
dissolved in a " half per cent, solution of iodine," 
instead of iodide of potassium, which was intended. 
The table on page 849 is also incorrect in its per- 
centages, and the illustrations are a disgrace to 
the present advancement in drawing, coloring, 
and wood engraving, comparing it with our new 
medical works. The illustrations on pages 95 and 
96 are simply disgraceful, both to the author and 
publisher. There are other matters which impair 
very materially the usefulness of the work ; as, for 
instance, figure 13 ; it is entirely unfitted for the 
use of the student, to direct him where the tym- 
panic membrane is to be sought for. In the second 
part, " Diseases of the Internal Ear," the latest views 
are not recorded with respect to the relations which 
the planes of direction of the semi-circular canals 
have to their function of enabling us to appreciate 
movements in the various directions ; and M. 
Cyon'sf observations of the relations of the oto- 
liths in the ampullae and the fluid of the semi- 
circular canals, to the periorbital muscles and 

* '* A Practical Treatise on the Diseases of the 
Ear." By D. B. St. John Roosa. m.d." Fourth 
edition. Wm. Wood & Co., New York. 1878. 

t Paris Acad^mle des Sciences, Dec. Slst, 1878. 



Jan 1 8, 1 879. 1 



Communications. 



49 



visja! vertigo, which we have before referred to. 
Tinnitus aurium, which in his prior editions re- 
ceived no attention at his hands, has but little or 
no light thrown upon it, although it is alluded to 
under at least eight different heads. The idea is 
still maintained, that it is the result of an irrita- 
tion of the acoustic nerve by the various morbid 
processes which affect the middle ear and laby- 
rinth. He makes no reference to Itard, and other 
French observers, who teach that tinnitus is due to 
trophic affections of the fifth nerve, producing sub- 
jective sounds precisely analogous to those visual 
sensations in which the peripheric organ of sight 
takes no part. No mention is made of the investiga- 
tions of Dr. Eichardson* of London, who calls at- 
tention, among the functional diseases from the 
abuse of alcohol, to subjective noises in the ears as 
one of the symptoms often present with alcoholic 
dyspepsia, mascse volitantes, vascular changes in 
the skin, etc. These noises are caused, he says, 
by reduced vascular tension, especially of the in- 
ternal carotid artery, and that he has known such 
complete and prolonged relaxation of the artery, 
that for months together it revealed one continu- 
ous murmur, compared to the sound of a torrent of 
water, or the grinding of a mill, or the whistle of 
a steam engine. 

No notice is taken of " Gruber's " method of 
washing out the tympanum through the nostrils 
and Eustachian tubes, when the membranes are 
absent, which has been revived by Weber-Liel, 
and found so useful ; and Weber recommends the 
cleansing the naso-pharyngeal space with weak 
solutions of bicarbonate of soda, while our author 
still adheres to the risky plan, according to his 
own showing, of using solution of chloride of 
sodium. We see no account of Gruber's method of 
making the patient pronounce the words, "hack, 
heck, hick, hock," for the purpose of inflating the 
middle ear, which is an effectual and pleasanter 
way than the old, swallowing of water, process. 
{To be Continued.) 



THOUGHTS ON MIDWIFERY, No. 2. 

BY HIRAM CORSON, M.D., 
Of Conshohocken, Pa. 

When my former paper was sent to the Re- 
porter, it was my intention to follow it by 
another, on post-partum hemorrhage, suggested by 
the papers read before the society by Dr. Wilson, 
of Baltimore, and Prof. Penrose, of Philadelphia, 
and by the discussion to which they led. I now 
prefer to pass by that subject, and comment some- 
what further on the lacerations of the cervix uteri 

* Diseases of Modern Life. 



and perineum which occur so frequently during 
labor. The opinion so boldly announced by 
several of the eminent men who participated in 
the discussion, and who, I may add, were nearly 
all teachers, " that the use of the forceps was not 
so likely to cause bad results — such as the lacera- 
tions referred to — as the allowing the labor to con- 
tinue its natural course," though delivered by 
" those having authority," was not new to me ; for 
I had heard it time and again from lips of young 
graduates, fresh from the colleges in which those 
professors teach. All over the State we have 
practitioners of only a few years' standing who 
talk as flippantly — I should have said as authori- 
tatively — on the subject, as do the teachers whom 
they so reverently follow. It does not seem to 
have occurred to them that a teacher of midwifery 
may be in error, or ride a hobby too long and too 
hard, and lose his way. There are in all great 
cities where medical colleges are located many 
practitioners of medicine who are as experienced 
in midwifery and as skillful in all its branches as 
the professors in the colleges, who often furnish 
valuable essays to the medical and obstetrical 
journals, but their writings fail to make much im- 
pression on those who have recently received in- 
struction at the colleges. They regard their " old 
Professor " as the highest living authority ; his 
practice as the embodiment of the advanced, or- 
thodox practice of the times. How great, then, is 
the responsibility of those who train young men, 
hundreds of them annually, to go forth as aids to 
those who are to suffer the perils of childbirth. 
I am well convinced that the teaching of mid- 
wifery in our medical schools during the last ten 
years has been of a kind productive of disastrous 
results, and it was, therefore, not pleasant to dis- 
cover that a number of the prominent men of the 
society of which I have spoken were deeply in- 
doctrinated with the belief that the womb is a 
very inefficient and wayward organ, which can 
rarely be confided in to effect delivery ; " that it 
is cruel to let the woman suffer," and that the 
forceps are safer than nature. And here allow me 
to say that those who held this belief were, almost 
without exception, teachers of medicine. No 
wonder, then, that the very air of our State is filled 
with it. 

Since I last wrote I have been present at an 
operation by Dr. Goodell, at the University Clinic, 
on a poor woman who had suffered for several 
years from ulceration of the cervix uteri. Wh it 
she had suffered during those years no one not 
thus afflicted can imagine. Would that every 
man who practices midwifery could read the 
graphic description of such a patient's condition, 



5° 



Communications. 



[Vol. xl, 



given by Dr. Goodell in his address on Obstetrics, 
before the State Medical Society, and published in 
its Transactions for 1878. If, after having read 
that paper, he could, in his subsequent pTactice, 
" hurry up " a labor, to save time to himself, or 
through a desire to see whether he could " effect 
forcible dilatation " and " deliver at the superior 
strait," or from fear of convulsions or hemorrhage, 
then he would prove himself unfit for his calling. 
I have intimated that the unnecessary meddling 
with cases which are progressing in a natural way, 
by using various means to dilate the mouth of the 
womb, and then to urge the uterus to more power- 
ful contraction by the use of medicine, or to resort 
prematurely to the forceps, is the main cause of la- 
cerations of the cervix uteri and perineum. Is there 
good ground for this belief? In the address of Dr. 
Goodell, already referred to, he says : " The cervix 
uteri often gives way daring labor, far more 
frequently than it ought, far more frequently, 
indeed, than it would, were nature allowed to take 
the lead. In these busy days there is unfortu- 
nately a tendency to urge on labor, more, I fear, 
for the sake of the physician than for that of his 
patient. The means used for this purpose are 
early rupture of the membranes, administration of 
ergot, and use of the forceps before the os uteri is 
dilatable.'' I might quote, to the reader's ad- 
vantage, the much more that he has on this sub- 
ject, but let this suffice. 

In looking over the report of Lycoming county, 
published in the Transactions, I find the following 
from Dr. G. D. Nutt, of Williamsport. " Within 
the pa«t six months I have been consulted in four 
cases of ruptured perineum. In two the sphincter 
ani was involved, giving rise to periodic diarrhoea. 
One of these cases was treated, during six months, 
by her physician. The case was cured by an 
operation. The other case has been suffering for 
five years, and was attended for two years by her 
physician without suspecting the cause. The 
amount of suffering this woman had endured, to 
say nothing of her uncomfortable and disgusting 
condition, is enough to awaken the sympathies of 
the most indifferent." 

Such is Dr. Nutt's published report. Four cases 
within six months, in a mere country place ; and 
they suffered greatly. Now, were these unavoid- 
able lacerations? I think not. If the mother 
had been let alone, not interfered with by a 
meddling doctor, who had been taught that it was 
cruel to allow a woman to suffer the pains of a 
natural labor, that the labor could be shortened, 
many hours, by forcible dilatation of the os uteri, 
or by the application to it of belladonna, or by 
flooding it with hot water and then resorting to 



the use of the forceps, even though it were " high 
up," there would most likely have been no lacera- 
tions. But this is only my supposition. To learn 
the facts I wrote to Dr. Nutt, and he kindly sent 
me this answer : " I am happy to give you the 
desired information. In two of the cases the 
forceps were used, and were, I think, the cause of the 
trouble ; for, from the patient's testimony, the doctor 
was in a great hurry, and hurt her very much. Of 
the other two, one was given ergot, and the other was 
given ergot and the forceps used too. Since writ- 
ing the report another case has fallen into my 
hands, caused by the use of ergot. In writing of 
these cases I will not omit a case of my own which 
happened to me some years ago, in my earlier 
practice, and which opened my eyes to the danger 
of using the forceps. In order to deliver the 
woman quickly I used the forceps, and thought 
my labor over, but after four weeks' attention I 
made an examination and was surprised to find an 
extensive rupture of the perineum ; although the 
case has been partially relieved by an operation, 
yet I have never forgotten the lesson I learned 
through bitter experience." 

Such is the statement of Dr. Nutt, and it really 
seems to make positive what with me was only 
supposition, namely, that these four women 
were maimed for life because of a meddling 
doctor, or doctors, who were in a hurry. I have 
no words to express properly my contempt for the 
doctor who would endanger the life and destroy 
the health of a woman in her hour of peril be- 
cause he was in a hurry ; so, for the present, 
will let it pass. But what have we here, from a 
single physician of a small town, where there are 
several other physicians, probably quite as emi- 
nent, and as likely to be resorted to for the relief 
of such injuries ? Five cases of laceration of the 
perineum in a few months. If the others could 
make like reports how numerous must the cases 
be in a single county. And what the cause? 
Meddling. Not one of the six was unavoidable. 
The doctor, in a hurry, disregards the fact that 
the time for interference has not arrived, and 
reckless in relation to what might happen to the 
mother and the child, commits an act on which 
he plumes himself as having proved his ability to 
shorten the duration of labor many hours, which 
his teacher had told him might be done with 
greater safety to the patient than if she were 
allowed to depend on the slow, painful efforts of 
the womb. 

This statement from Dr. Nutt almost frightens 
me. It is far worse than I had believed the facts 
to be, and yet it probably does not come up to the 
whole truth, for it speaks onlv of laceration of the 



Jan. 1 8, 1879.1 



Communications, 



51 



perineum, and if we could follow that hurried 
doctor, and ascertain the extent of the injuries 
which he has inflicted, we would probably find 
that in addition to the injuries to the perineum, 
the cervix uteri had oftentimes suffered. We 
would no doubt be able to discover that some pa- 
tients had died after confinement, from peritonitis, 
the result of laceration of the cervix uteri, an 
injury which he had not suspected ; for Dr. Good- 
ell says, " If union of the lacerated cervix should 
not take place, dangerous inflammations will 
occur." This injury is rarely suspected by the 
accoucheur, and yet so frequently does it occur, 
that one writer states that of the women who 
apply to him for treatment of uterine disorders, 
forty per cent, exhibit lacerations of the cervix 
uteri ; and our own Dr. Goodell " infers that about 
one out of every six women suffering from uterine 
trouble has an ununited laceration of the cervix ; 
and as an evidence of its frequency I may add, 
that I have operated for this lesion eighteen times 
within the past twelve months." I pause a 
moment, to say that this address by Dr. Goodell, 
which is hidden away in our "Transactions," 
should be published in every medical journal on 
the continent, as a warning to doctors against haste 
and recklessness. 

If the disasters to which I have alluded are the 
results of erroneous teaching, and if the experience 
of Dr. Nutt and Dr. Goodell are true indications of 
what are occurring all over the land, who can 
compute the number of lacerations produced annu- 
ally, or have a just conception of the amount of 
suffering entailed on the women of Pennsylvania 
by erroneous teaching ? I say erroneous teaching, 
for do not we follow masters — masters teaching in 
New York, Buffalo, Philadelphia, Baltimore, 
Boston, etc.? We distrust nature ; we fear that we 
may wait on her too long, or that " something is 
wrong," or that " the woman is being worn out ;" 
and, deeply impressed by the teaching that the 
forceps are easier, safer and more efficient than the 
natural forces of the patient, we resort to them 
hours before an experienced practitioner would 
consent to use them. 

Teachers are prone to lay down positive *' rules," 
and to so magnify the dangers of any departure 
from a rule, that young men are all the time on 
the watch for diasters. An example of this was 
given during the discussion in the Society, when a 
professor " regarded the most important point in 
Dr. Emmet's paper to be his statement with refer- 
ence to the exact time when the forceps should be 
used, and that was immediately when the head 
ceased to recede after the occurrence of a pain. 

n that respect the time was definitely fixed, and 



was a most practical teaching. A delay of fifteen 
minutes at that time was dangerous, and the patient 
was placed in the greatest peril unless delivery was 
speedily effected." What other accoucheur, of even 
ordinary experience, would be willing to say that 
the woman was then in the greatest peril ? If in 
so great peril in fifteen minutes, was she not in 
peril in ten minutes ? Why wait at all ? A young 
man thus taught would feel it to be incumbent on 
him to be constantly on the watch, to feel every 
pain and determine positively whether the head 
receded or did not. He thinks it does not recede ; 
he is alarmed; he remembers the words of his 
teacher, " the woman is in the greatest peril," and 
then, in all haste, regardless of the condition of 
the patient, who is unconscious of danger, and 
exhibits no sign of sudden change — indeed, of any 
change at all — proceeds to deliver speedily ; a 
delivery which, in the hands of a skillful, well- 
practiced man might terminate well, but which, in 
the hands of a frightened, inexperienced one, 
would likely result in a laceration of important 
tissues. 

Let us suppose, now, that the declaration al- 
luded to had been made in that meeting by any 
one there not a professor, say by Dr. Ellwood 
Wilson, or Dr. Albert Smith, or Dr. Goodell, any 
one of whom is equal in skill and experience to 
the author of it ; in that case it would have worked 
but little mischief; the few persons present were 
men able to put it face to face with their expe- 
rience, and to decide on its value ; and after that 
it would have been hid away in an obstetrical 
journal, perhaps, and would have reached scarcely 
one in a hundred of the physicians of our country. 
But not so when it is the utterance of a teacher of 
hundreds of young men. What was said in that 
meeting will be impressed on the minds of these 
coming doctors, most emphatically, in his course 
of lectures this winter, and they will carry it with 
them into every State in the Union. If it be true 
that danger so imminent threatens the patient, 
and that to use the forceps at once is her only 
safety, then it is well. If not, then no one can 
measure the extent of injury wrought by it. 

My experience, in cases which are numbered by 
thousands, is not in accord with that declaration, 
and it was, therefore, pleasant to know that Dr. 
Barker, of New York, " regarded it a very uncer- 
tain rule to resort to the use of the forceps when, 
in the interval of uterine pains, the head ceased to 
recede." 

It would seem, from what I have written, that I 
am wholly opposed to the use of them. I am not. 
To me they are of inestimable value, and I incline 
to the belief that, even in Dr. Nutt's cases, a skill- 



52 



CommunL at ions. 



Vol xl 



ful man, not in a harry, might have used them 
without doing harm ; and yet, very likely, nature 
could have done it better. In my next paper, on 
Post-partum Hemorrhage, I hope to show that 
professors of midwifery, not alone of this or that 
particular school, impress so strongly on the 
minds of their students that fearful perils environ 
the lying-in woman, and attend every step of the 
labor, that they are, through fear for her safety, 
impelled to interfere with even the most natural 
and safe ones. 



CASE OF EXTEA-UTEKINE PEEGNANCY, 

BY FRA-NKLIN HINKLE, M.D., 
Of ColumbLt, Pa. 

I was called, June 23d, 1876, to visit Mrs N. 
C, of Marietta, Pa., aged twenty-three years, 
married one year, who I found enceinte and labor- 
ing under violent peritonitis, the result of riglit 
tubo-ovarian pregnancy of four months. 

She became pregnant about the middle of Feb- 
ruary. At this time she witnessed an accident to 
a young maa of her acquaintance, who was killed 
on the railroad, in front of her door. After this 
she experienced a great nervous shock, giving rise 
to a slight catamenial discharge, and from that 
time until I was called in she had been more or 
less indisposed. With proper treatment peri- 
tonitis was allayed, and she recovered, July 10th. 
My diagnosis was based upon the following facts : 
Patient had a slight sign of the catamenial period. 
After this she did not menstruate, but had, at 
irregular periods, a reddish, watery, vaginal dis- 
charge. Her digestive organs were very much 
disturbed by nausea, and an immoderate appetite 
for indigestible food, and she had a special longing 
for lemons. Thus the first two months passed, with 
the usual suflPerings attending pregnancy. 

In April, May and June, and at last weekly, she 
would be taken, in an instant, with excruciating 
colicky pains in the region of the right ovary. A 
fixed point, as she said, for the pain seemed to 
come from a spot not larger than a silver dollar, 
and continued for hours, and sometimes for days. 
The bowels now became constipated, never moving 
except by purgatives or enemata, and she suffered 
for some days the most excruciating pains in mic- 
turition, which were relieved by hypodermic in- 
jections of morphia and atropia. 

The gradual enlargement of the breasts and the 
discoloration around the nipples were found to 
correspond with the pregnant condition. In the 
latter part of summer the breasts became fillled 
with milk. 

Examination showed the uterus enlarged to 



the size usually found at the third month, but 
high up, and it was with difficulty that the os 
could be reached with the index finger. The vagi- 
nal wall was pressed heavily forward to the right, 
by a large sac filling up the entire right sacro- 
iliac fossa, and dipping deep into the pelvis. The 
right an I external w ill and inferior part of the 
sac were firm, and of a doughy feel upon pressure, 
while the anterior superior wall was thin, as 
though nothing but the wall of the vagina inter- 
posed. The contents of the sac could be distinctly 
felt, an! in August I was positive that I could feel 
the head and extremities! of a foetus. This, with the 
pathognomonic signs — the sudden colicky piinsin 
the right ovary, with the bloody, watery discharge ; 
the enlarged uterus filled with the membrana 
decidua, while the right side was filled by the fetal 
tumor ; breasts enlarged and filled with milk, com- 
prised my cautious, though positive diagnosis, 
given in the fifth month of her pregnancy. 

August 29th, on account of exposure, she had 
another slight attack of peritonitis, from which she 
recovered September 7th, and from which time I 
did not see her again until November. No v. 20th 
she was taken with labor pains ; had natural dis- 
charges from the uterus, of liquor amnii, which 
was tinged with blood. After suffering all night 
she was seized with violent spasms. 

Prior to this, through the months of August, 
September and October, she had felt the move- 
ments of the fcetus, but after the spasms they 
ceased. I then strongly advised the family as to , 
the propriety of an operation, but without success. 
January 1st, 1877, she was again seized with a 
chill and peritonitis. 

Her family physician attended her up to the 
17th instant, when I was again called. I found 
her with a dead foetus in the abdominal cavity 
and suffering from peritonitis, which continued up 
to February 1st before it was checked. 

During this month she lay in a prostrate condi- 
tion, suffering from diarrhoea, and discharging 
feculent, mucoid matter, due to the discharge of 
portions of the dead foetus. Her constitutional 
symptoms were very grave. She was extremely 
emaciated and in a cachectic condition, with very 
feeble pulse. Although orders had been left that 
all fecal matter discharged should be kept for 
my inspection, I found that several evacuations 
were thrown out without my seeing them. 

March 3d, she passed a large fleshy mass, to- 
gether with the left femur, which dropped into 
the chamber, and first called the notice of the 
nurse to the fact. 

Three days later I visited my patient, prepared 
to operate, but found that she b^d had a chill 



. Jan. 1 8, 1879.] 



Hospital Reports, 



53 



during the night, followed by a heavy, cold per- 
spiration, with feeble pulse, which continued for 
nearly twenty-four hours. I, therefore, deemed it 
imprudent to operate, and was compelled to use 
powerful restoratives to resuscitate her. 

March 10th. She passed, per rectum, the iliac 
bones, sacrum and seven lower vertebrae, with the 
intestinal tube and thoracic viscera, en masse. 

The following day she appeared better. Sp. gr. 
of urine eight below normal, pulse 89, soft and 
compressible, and appetite improved. The re- 
maining fetal bones could be distinctly felt 
through the abdominal parietes, and fearing an- 
other attack of peritonitis, I performed the opera- 
tion of gastrotomy March 12th, at 11.30 a.m., 
assisted by J. Agustus Ehler, m.d., of Lancaster, 
and my student j Mr. Houston Mifflin. 

I considered the operation of gastrotomy neces- 
sary, for the reason that the greater part of the 
foetus had passed through the abdominal canal, 
and therefore, thought there must be a fistulous 
opening through the rectum, and very probably I 
would find the remainder in the abdominal cavity, 
as the bones could be distinctly felt, and I believed 
her past sufierings were all owing to this cause. 

An incision was made, five inches in length, 
through the linea alba, from the umbilicus down- 
ward. I found the peritoneum much thickened, 
and considerable serum escaped from the incision. 
In the ascending colon were a number of bones 
lying obliquely across the canal, which acted as a 
barrier, preventing any rectal discharge, and no 
portion of the foetus remained in the abdominal 
cavity ; all had found their way into the intestine, 
and the fistula was closed. I then requested my 
friends to make an examination, and they con- 
curred in my opinion. I thought I would not be 
justified in opening the intestine, so, after separat- 
ing the bones along the intestine, I closed the 
•wound. She rallied after the operation, had no 
inflammation, and the parts healed kindly. March 
13th, she passed a comfortable night, suffered less 
pain than before the operation, no fever, pulse 
good, stomach weak and only able to take liquids. 

The remaining bones did not pass per rectum, 
and could not be detected afterward. I regret 
now that I did not open the bowel and remove 
them. 

Patient made a good recovery from the opera- 
tion, but on the night of the eleventh day after 
the operation she had a violent chill, with fever 
and sweats. 

On the 13th day she vomited and spat purulent 
matter. It was a septicaemic abscess of the lung 
which caused death, about eleven days after the 
operation. 



My patient should have let me operate soon 
after her recovery from the labor which left the 
foetus free in the abdominal cavity. The case was 
of the tubo-ovarian variety of extra-uterine preg- 
nancy, from the fact that the liquor amnii passed 
off" per via naturales, with hemorrhage, and I think 
that the shock she sustained from the fright, 
occurring at the time the ovum was on its way to 
the uterus, induced a spasm of the tube and deten- 
tion of the ovum. Hence the cause of the abnormal 
pregnancy. 



Hospital Reports, 



PHILADELPHIA HOSPITAL. 

CLINIC OF DR. JOHN H. BRINTON, DECEMBER 

14Lh, 1878. 

EEPORTKD BY DR. W. M. ANGNEY. 

Sprains. 

Gentlemen : — I wish, this morning, in the 
first place, to invite your attention to the subject 
of sprains. These injuries, as yon know, are ex- 
ceedingly frequent, and are rather lightly regarded 
by the community. " It is only a sprain," is a 
common expression, and a sprain is considered as 
I scarcely deserving of sympathy ; and yet, gentle- 
j men, I can assure you that a sprain is sometimes 
j a most serious matter, involving not only present 
I suffering, but often followed by chronic lameness 
j and wearisome impairment of the function of the 
I parts. I use the word wearisome designedly, for, 
I indeed, it applies not only to the patient, Ijut to 
, the surgeon also. Recovery from a bad sprain is 
' at times painfully slow ; the sufferer loses heart, 
1 and may be almost pardoned if now and tlien his 
faith in his professional adviser be shaken. 

Now, gentlemen, what is a sprain? It is essen- 
tially a strain, or wrenching, or twisting of the 
tissues which surround a joint, involving alike the 
ligamentous fibres, the fibrous capsule or involu- 
crum", the tendinous cords, the synovial prolonga- 
i tions and sheaths, and I suppose also the muscu- 
lar structures, where such exist in the neighbor- 
j hood of the articulation. The sprain may involve 
some or all of these tissues, and may vary in 
^ degree from the slightest abnormal stretching up 
I to laceration and divulsion of the parts. You all 
know the characteristics of a sprain, and I am 
sure I need only refer to such an experience as an 
ankle " turning under you" to bring vividly to 
your minds the salient points of such an injury. 

The first and most prominent of these symptoms 
is pain. This varies in degree, according to the 
amount of violence and the nature of the joint. 
The sprain of a tight, compact joint, such as a 
hinge joint, is greater, ordinarily, than that which 
is experienced in a like injury of an orbicular 
joint, and you will readily understand why this 
should be so. The tighter the tissues, the more 
tense they are normally, the more will they be 
stretched and lacerated by a given amount of 
force. On the other hand, the looser they are, the 
greater the degree of normal motion in every 



54 



Hospital Reports. 



[Vol. 



direction, the less likely is lesion of the joint 
structures to happen. Thus it is that the hinge 
joint suffers more than does the ball and socket 
joint. The pain of a sprain, therefore, varies ; it 
may be very slight, or it may be intense, almost 
unbearable. Oftentimes it is of a nauseating 
character, especially, I think, when the violence 
has fallen upon lateral ligaments. 

Another symptom is the swelling which accom- 
panies a sprain. If you examine a joint, say an 
ankle joint, immediately after such an accident, you 
will find that there is good deal of extravasation. 
Blood has escaped freely into the tissues below the 
malleoli, and the parts are puffy and discolored. 
In a little while effusion of serum occurs, the 
front of the ankle and the dorsum of the foot 
become infiltrated, and the skin appears tense 
and shiny. Impairment of motion is another 
symptom of the injury. You would naturally 
expect that this should be so, as an accompani- 
ment or sequence of the symptoms just referred to. 
The joint is usually very tender, and immovable ; 
that is to say, the patient cannot move the articu- 
lation ; it hurts him to do so, and therefore, he will 
not. Nevertheless motion is there, and may be 
developed by the surgeon's manipulation, either 
with or without the administration of ether. This 
is an important point, and must not be overlooked 
in arriving at a differential diagnosis as to the ex- 
istance of sprain, fracture, or luxation. 

What is the treatment of sprain ? The first 
duty of the surgeon in such a case is, of course, to 
establish his diagnosis. If necessary, as I have 
just said, anaesthesia may be demanded. The 
sprain, however, once determined upon, the treat- 
ment may then be divided into the acute and 
chronic. The usual and prominent features in 
the former are, rest, and the antiphlogistic appli- 
cations of cold water, lead water, lead water and 
laudanum, and other like local agents. They are 
all very good, and you will find them very useful. 
But there is one application which I will tell you 
of, and recommend to you ; it is the use of hot 
water. I do not know that it is particularly new, 
but I am sure that it is not in as general use as 
it might be. A good many years ago I was, one 
morning, passing a theatre, where, standing on the 
steps, I saw that most excellent surgeon, since 
gone, Dr. Paul B. Goddard. He called to me, and 
asked me if I knew how to treat a bad sprain, 
adding, "come in, and I will teach you some- 
thing." I went in, and then found that a star 
foreign actress, a large, heavy woman, had jnst 
turned her ankle, was suffering greatly, was unable 
to take her part in rehearsal, and it was feared 
would not be able to sustain her role in the even- 
ing's performance. Dr. Goddard directed her to 
place her foot and ankle in a bucket of hot water, 
when more hot water was slowly poured in from a 
kettle, until the highest endurable temperature 
was reached. The limb was then retained in po- 
sition for some fifteen minutes, the pain gradually 
decreasing until it passed away. As the pain 
vanished, the motion returned, and the lady was 
enabled to play her evening's part without a limp, 
and without pain. This case made a great im- 
pression on my mind, and I tell you the anecdote 
for the sake of the moral contained, viz., the early 
use of very hot water in sprains, particularly of 
the ankle joint. 



Unfortunately all sprains do not come to such a 
speedy and satisfactory termination. In many 
cases the tendency is to become chronic. The 
case lingers on ; if it be a sprain of the ankle or 
of the knee there may be entire comfort when the 
part is at rest, but a recurrence -of pain on walk- 
ing. Or, in some cases, the patient may be able to 
walk for a little while without material inconveni- 
ence, and yet find, later, a return of shooting pains. 
Or, again, partial motion of the joint only may be 
present, extreme flexion or extension being accom- 
panied by suffering. What does all this mean? 
Simply this, that a secondary inflammation, to 
a lesser or greater degree and extent, has taken 
place, and the indication of treatment must be 
found in rest; not occasional, spasmodic rest, at 
the patient's option and caprice, but absolute rest. 
In my own experience I have found that this can 
be best obtained by the application of a permanent 
dressing — the starched bandage, the gutta percha 
splint, or the silicate of soda dressing. In ordinary 
cases I prefer the latter. The gutta percha splints 
are expensive, and are apt to become brittle and 
crack. The starched bandage takes too long to 
harden. The silicate of soda seems to me almost 
perfect. I use it very frequently, and I will now 
show you how it is to be applied. 

Here is a patient who some time since fell and 
sprained his ankle. Immediately afterward he 
had all the symptoms I have described, and he 
has been confined to his bed for some weeks. The 
strictly acute symptoms have, however, now passed 
away, but, as there is yet some lingering tender- 
ness and pain upon motion, even when effected 
passively, I have determined to put the part at 
rest by the use of the silicate of soda dressing. 
Notice how this is made, I first apply a roller 
bandage from the toes to the knees, and over this 
I paste, if I may use the word, a series of short 
strips of bandage, or muslin, saturated with this 
solution of the silicate, until the whole limb is 
surrounded with a coating five or six layers thick. 
Over the whole I then apply another dry roller, 
and allow the dressing to dry, which it does in 
fifteen or twenty hours. When the apparatus 
shall have become firm and solid, I shall cut 
it down the front of the leg, with these strong 
pliers, made for the purpose, and take it off. 
I shall then bind the divided edges of the splint 
with a silicate strip, and run a single strip 
up the inside, to prevent the reverses of the first 
roller from being displaced. The splint will look 
like this one on the table, which was removed 
some time since, from a patient in private practice. 
What use will I make of this splint when once it 
is finished? Just this ; I shall have it applied by 
an ordinary roller bandage ; let the patient walk, 
at first with crutches, and afterward with a cane. 
I shall direct this splint to be removed daily, the 
limb d(?ached with cold water, and then the splint 
reapplied. He will easily manage all this him- 
self, and will soon become very expert in the 
management of his leg. This treatment will be 
continued as long as there is any tenderness 
around the articulation. The object of my en- 
deavors is to enforce perfect rest of the joint until 
the chronic inflammation and effusion shall have 
disappeared, and this is the only secret of the 
treatment. If at any time, in following out this 
plan you should detect any tendency to unusual stiff- 



Jan. 1 8, 1879.J 



Hospital Reports, 



55 



ness of the joint, you should make gentle passive 
motion daily, or, if you choose, you may direct 
the systemati(i massage which has recently been 
so much resorted to in chronic surgical troubles, 
and which at times almost seems to work wonders. 

Erysipelas. 

I will next bring before you two patients suffer- 
ing from erysipelas. The first of these is a laborer, 
thirty-eight years of age, Irish, and unmarried. 
He tells US that he is a sober man and not addicted 
to drink, at all events to any excess, and that he 
has recently been working very hard, on the rail- 
road. During this time he says that he has been 
exposed to cold, but that he has received no fall, 
or other mechanical injury. Yet he is evidently 
suffering from serious trouble ; notice, if you 
please, his face and scalp. You see that they are 
greatly swollen, his face is dusky red and distended, 
pitting upon pressure ; and the tumefaction in- 
volves the upper and lower eyelids of each side, so 
as almost to close the eyes. The palpebral con- 
junctivfe are inflamed, with purulent secretion. 
The lips are greatlj increased in size, and so, also, 
are the ears. On the latter the skin is tense and 
shining, the lobule is enormously swollen, and the 
integument of the concha almost occludes the 
opening of the external meatus. On portions of 
the face you may notice little vesicles ; in some 
spots they have burst and the torn cuticle forms 
small, rough eminences on the inflamed skin. 
His condition is feverish, his temperature is high, 
varying from 102° to 103°, and he complains of a 
burning sensation over the affected parts. His 
intellect is clear, and he answers rationally ques- 
tions put to him. He can assign no cause for his 
trouble ; he attributes it to cold and exposure, and 
he has not been near any one similarly affected. 
Now, what is this disease ? Manifestly erysipelas, 
of the oedematous type. 

Here let me say a few words to you concerning 
erysipelas, for it is one of the diseases too fre- 
quently met with by the surgeon, and, as you can 
readily imagine from the appearance of the case 
before you, is one well calculated to excite alarm 
in the minds of a patient and his friends. 

Erysipelas is usually defined to be an inflam- 
mation of the skin, involving to a greater or less 
extent the subcutaneous tissues, and with a marked 
tendency to extend and spread rapidly. The 
disease may present itself as simple erysipelas, 
when the inflammation is confined to the skin 
proper; oedematous erysipelas, when there is 
marked effusion of serum, as in the patient before 
us ; and phlegmonous erysipelas, in which the 
cellular and fatty tissues are largely involved, 
with a strong tendency to suppuration. Another 
classification is into idiopathic and traumatic 
erysipelas. The former arises chiefly from con- 
stitutional causes, while the latter is the result of 
local disturbance, following operation, injury, or 
open wound. 

The constitutional symptoms of the affection, 
when ^severe, are sufficiently pronounced. Fever, 
oftentimes preceded by chill, a coated tongue, be- 
coming dry and brown as the disease advances ; 
a temperature running up to 103° or 104°, and 
Ijw, disordered intestinal function. Usually there is 
^^constipation, occasionally diarrhoea. The urine is 

I 



high colored and diminished in quantity, and fre- 
quently albuminous. The pulse is mostly quick, 
and at times irregular. In severe cases, especially 
of the head, delirium is present, and is an un- 
favorable symptom. 

The treatment necessarily depends upon the 
gravity of the cases. In the patient before us, the 
affection has, I think, reached its acme, for I ob- 
serve here and there little wrinkles forming in the 
skin, showing that the tumefaction is on the de- 
crease. He tells us, too, that he is better than he 
was yesterday, and that the burning and heat of 
the part is not so great. I shall order for him a 
simple treatment ; the part will, for the present, 
be covered with a cooling lead water and lauda- 
num solution. Later in the case I shall, probably, 
order an application of the oxide of zinc. Inter- 
nally, he will take the muriated tincture of iron, 
twenty drops four or five times a day. This 
preparation is, I think, the one most to be trusted 
in the treatment of erysipelas, and there can be 
no doubt that it exercises great influence over the 
progress of the disease. To be of service, it ought 
to be freely administered. The only difficulty I 
have met with in its exhibition is its tendency, at 
times, to disagree with the stomach, and to excite 
distress and prolonged nausea and vomiting. In 
such cases its discontinuance is unavoidable, unless, 
by combination with gentian, quassia, or some 
other bitter tonic, its presence can be tolerated by 
the stomach. 

The administration of quinine, to the extent of 
ten or twelve grains a day, is also a matter of 
importance in this disease ; so, also, is the diet. 
The old idea of starvation and a Ioav regimen 
is no longer entertained ; on the contrary, the 
patient should be supported by the best of nour- 
ishment the stomach will bear — milk, beef es- 
sence or tea, and stimulants as required, in the 
form of milk punch or otherwise. Personal clean- 
liness, «nd thorough ventilation of the room or 
ward, are, moreover, matters which should be 
carefully looked after. The absoluie necessity 
of isolation of an erysipelatous case is much in- 
sisted upon. It is usually stated that there is al- 
ways in this disease a tendency to infection, and 
unless the patient be strictly secluded, and kept 
apart from others, much mischief may accrue from 
the spreading of the disease from bed to bed. 
For my own part, however, I am inclined to 
doubt, whether in civil practice, and in hospitals 
under proper hygienic regulations, such is the 
case, at all events to the extent supposed. 

The prognosis in a case of simple or oedematous 
erysipelas is not usually grave. In the phlegmo- 
nous form, however, especially if the head be the 
affected part, the reverse is the case. Great 
danger here may arise from the extension of the 
inflammatory condition to the brain or its mem- 
branes. In phlegmonous erysipelas the accompa- 
nying suppuration is often wide spread, and 
exhausting to the patient's strength. It must be 
met, and met promptly, by free openings and 
incision-^!, to further the escape of the purulent 
matter, and by a judicious use of disinfecting 
agents, such as Labarroque's solution, solutions of 
carbolic acid, and the employment, when there is 
much destruction of the superficial tissues, of light 
charcoal or yeast poultices ; of course, in such 
ca es, tJiere is an increased drain upon the system ; 



56 



Med cal Societies. 



[Vo'. xl. 



and therefore a proportionate necessity for consti- 
tutional support and stimulus arises. 

In the liglit case of the oedematous form of the 
disease which I have brought before you this 
morning I shall confine my treatment to the 
simple remedies I have indicated in his case, and 
I doubt not that I shall bring him before you at 
my next clinic materially improved, if not, indeed, 
entirely convalescent. 

Here is another case of erysipelas, of the 
phlegmonous variety, a graver form of the disease. 
This man tells me that he is about forty years of 
age, that he is a hard drinker, given to periodical 
excesses, and that he has recently been on a 
debauch. On coming to his senses he found that 
his leg had been excoriated or scratched, just above 
the ankle, as he thinks, by a torn boot. Observe, 
now, the condition of the limb ; it is enormously 
swollen, in fact, it is twice its natural dimensions. 
The skin is intensely injected, some of the vessels 
are of large size, and present an arborescent 
appearance. The heat of the part is much in- 
creased, and I can readily detect the difference in 
temperature between the two limbs. When I press 
on any part of this tumefied surface it pits, and 
the redness disappears, but on removing my finger 
both color and swelling return. On pressure the 
whole part feels boggy, and I am sure that the 
inflammation involves the superficial fascia, and 
probably has extended along the intermuscular 
cellular planes. The case is one of true phlegmo- 
nous erysipelas, and I am certain that suppuration 
is being established beneath the integument. 

The constitutional symptoms in this case are 
pronounced, but not to the degree you might 
anticipate looking at the local conditions. There 
is some pain, not a great deal ; fever, with a dry 
skin, coated tongue, increased temperature, and 
scanty, high-colored urine. He complains of 
inability to sleep, but the ward nurse says he sleeps 
very well. 

What shall I. do with this case ? In the first 
place, I must relieve the local tension, and let out 
t le pus. I will make an incision, and as I do so, 
you observe the flow of thick pus, and the pufiing 
out of the disorganized tissae^>. I shall have the 
limb poulticed, and the poultice changed every 
two hours. Internally I shall direct twenty-five 
drojjs of the muriated tincture of iron every four 
hours, and give him fifteen grains of quinine in 
the course of the twenty-four hours. At night, 
if there is insomnia, he will take an old opium 
pill, one grain, to be repeated if necessary. As 
tor his diet, I shall give him, as he can take it, 
the most nourishing food the house affords. If he 
has any difficulty in taking solid food, I shall 
order him milk. I have a high opinion of the 
milk diet when there is gastric irritation. In 
urethral fever, I have for years made use of it, 
and in urinary diseases generally ; and after opera- 
tions in the genito-urinary organs, I have found it 
of the greatest service. I do not doubt that this 
case of phlegmonous erysipelas will do well, un- 
promising as the appearance of the limb is just 
now, and I base my prognosis upon his present 
constitutional state. * ^ ^- * * 



— We would remind subscribers that at the first 
of the year the annual subscription falls due. 



Medical Societie«^. 
the ehode island state medical 

SOCIETY. 

The quarterly meeting of this Society was held 
December 18th, the President, Dr. E. T. Caswell, 
presiding. The President announced the death 
of the oldest Fellow of the Society, Dr. S. Augustus 
Arnold, in a few appropriate remarks. 

Dr. Turner, of Newport, made some remarks in 
regard to the attendance of physicians as witnessCvS 
in courts. He thought that some action should be 
taken to provide a law, ii possible, by which courts 
could have discretion to allow a reasonable com- 
pensation, as is done in other States. In the pres- 
ent state of the law in Ehode Island, it frequently 
worked great hardship in compelling long attend- 
ance with no adequate pay. 

The report of the Committee on the Adoption 
of the Metric System was read by Dr. J. W. 
Mitchell. It favored the adoption of the system, 
and closed with the resolution that on and after 
January 1st, 1880, the Ehode Island Medical 
Society would use it in practice. 

Dr. Williams, of Boston, was introduced to the 
Society. He made some remarks in regard to the 
institution of the Board of Medical Examiners 
recently established in Massachusetts, to have 
charge of cases requiring their services in connec- 
tion with coroner's inquests, and expressed his 
pleasure in being able to meet with his friends of 
the Ehode Island Medical Society. 

Dr. H. G. Miller, of Providence, gave an in- 
formal essay uj)on the treatment of nasal pharyn- 
geal catarrh, which was followed by discussion and 
suggestions by several physicians. 

Dr. Virgil D. Hardon, read a paper upon me- 
chanical dysmenorrhoea, which was followed by 
discussion. 

DIPHTHERIA. 

Dr. O. Whitney, of Pawtucket, read a carefully 
prepared essay on the subject of " Diphtheria." 
He quoted largely from prominent medical 
authorities in support of his conclusions as to the 
cause and treatment of the disease, which were 
presented, as follows : — 

1. There is but one pseudo-membranous disease. 

2. It belongs to the sanie family with influenza, 
which may, by the same nomenclature, be called 
the mucous disease, 

3. Both are iuflimmations of the same anatomi- 
cal structure, i.e.] the mucous membrane lining 
the nares, throat and primary passages to the 
lungs. 

4. The " flux," or product in influenza, is inno- 
cuous, and not capable of self-propagation. 

5. The " flux " in the pseudo-membranous dis- 
ease is concrete and raised to morbid specificity, or 
having self-generating powers. 

6. Both branches of this family of diseases have 
prevailed from titne immemorial, and are governed 
by the same general causes and influences, and 
modified by the country in which they may have 
prevailed and individual habits of the people. 

7. It is contagious or infectious in proportion 
to its visible putridity in individual cases ; the in- 
fecting power being of short duration. This self- 



Jan. 18, 1879.1 



Periscope. 



57 



generating power lies in both the breath of the 
sick, and in the more solid discharges from the 
affected surfaces. " There is no evidence that, as 
constantly happens in scarlet fever, the active con- 
tagiousness of diphtheria extends to a period of 
convalescence at which the accustomed duties of 
life can be resumed." There are some animal 
poisons which are known to increase in the severity 
of their action by successive inoculations, and to 
this class it seems probable that the infectious 
matter of diphtheria may belong. 

8. As in influenza, one attack of the pseudo- 
membranous disease gives no protection against a 
future ^attack. 

9. Both branches of this family of diseases have 
had a great number of names. 

10. In New England it has borne bad names 
among the laity, when in the concrete ; membra- 
nous croup and " putrid sore throat." In the pro- 



fession membranous laryngitis (eynanche trache- 
alis, obsolete since 1830), and eynanche maligna. 

11. When prevalent in the fluid branch, it has 
generally been known by the Italian word influ- 
enza, or influence. For some transient reason it 
was known as the " Tyler grip " in 1842. 

12. It is primarily a local disease, and its imme- 
diate effects in the pseudo-membranous branch 
depend upon severity and locality invaded. The 
remote results depend upon absorption of the de- 
composed concrete flux, or membrane. 

13. The remote results have a constant relation 
to the quantity of absorption, which takes place 
from the throat, little if any being absorbed from 
the larynx and parts below. 

At the conclusion of the reading, President Cas- 
well announced that, owing to the lateness of the 
hour, there could be no extended discussion upon 
the thoughts deduced by the essayist. 



Editorial Department 



Periscope. 

Digitalis in Heart Disease. 

We quote some further views of Dr. J. M. 
Fothergill on this subject. They are from a late 
address. He said he had used it largely and never 
seen accumulative effect, and had found no evi- 
dence of such. The only fear was of producing 
acute poisoning at the time. He had seen it pro- 
duce hard hammering action of the heart ; measur- 
ing its effect by the frequency of the pulse was ex- 
ploded. Digitalis increased the force of the ven- 
tricular contractions by its effect on the nerves. 
As Niemeyer said, it filled the arteries and emptied 
the veins. In dilatation witti frequent imperfect 
action, it reduced the rapidity of the pulse. Dr. 
Balthazar Foster found retardation of the pulse 
one of its effects. In aortic stenosis the hyper- 
trophied heart compensated. Digitalis was especi- 
ally of use in dilatation of the heart. One patient 
was taking at present twenty-drop doses of tincture. 
If" there were fear of the muscle failing, a little 
strychnia might be added. In feeble, irregular 
rhythm, it might be given without fear. In mitral 
disease it was useful, and was given to act on the 
right side of the heart. There was no difference 
as to its use between mitral obstruction and regur- 
gitation. It was especially useful in the bron- 
chorrhcea of mitral disease. In aortic stenosis it 
was rarely necessary to give it till the later stages. 
In aortic regurgitation it was not desirable to give 
it unless exceeding dilatation existed. When the 
patient lay in bed in hospital, small doses sufficed ; 
but when up, larger doses were required. Indi- 
rvidual peculiarities and the mode of preparation 
[of the digitalis must be borne in mind. In organic 
diseases digitalis was of use ; but in functional dis- 
orders it did no good. In chorea and in Grave's dis- 
ease bromide of potassium with belladonna was 



better than digitalis. In palpitation with chronic 
Bright's disease and gout, when the pulse was 
good, digitalis only produced more hammering 
heart action when the heart was beginning to fail 
and '' wanted to dilate." Digitalis might be added 
to potash treatment. In reply to an inquiry. Dr. 
Fothergill stated that he had no experience of 
digitalis in acute failure of the heart's action with 
delirium tremens ; he did not think digitalis had 
any effect in Bright's disease, as a diuretic. To 
give it in aneurism would be apt to rupture the 
diseased vessel. In reply to another question he 
stated that he had no preference for tincture or in- 
fusion, and considered its application by poultice 
uncertain and heroic. 



Thoracentesis in Ph hisis. 

In discussing a case in the Lancet, Dr. A. D. L. 
Napier writes — 

My principal object in bringing the case under 
the notice of the profession is to suggest inquiry as 
to — (a) Are we justified in treating cavities in 
phthisical lungs, as is mostly done, by non-inter- 
ference ? or (6) Would it be wise to have more 
frequent resort to operative procedure ? In many, 
I may say in most cases, in the third stage of phthisis, 
occurring in children, the existence of cavities is 
easily diagnosed. Were we to interfere as soon 
as a cavity could be discovered, by means of opera- 
tion, and the insertion of a drainage tube, with due 
antiseptic precautions, is it unlikely that lives 
could be prolonged, or mayhap saved, which 
otherwise would be inevitably doomed? As to the 
means of operating, I conceive that with a large 
trocar and canula, or even an ordinary stiaight 
bistoury, we are as efficiently a^med, and more so 
than with any of the existing aspirators. The ob- 
jections to aspirators in empyema have been well 
weighed ere now, and in country practice the more 
simple and familiar the instruments, tl.e more 



58 



Periscope. 



[Vol. xl. 



frequently will they be used. No diflSculty arises 
from antisepticism, as a small hand spray-pro- 
ducer, which can be easily managed by the most 
inexperienced, is quite sufficient for the purpose. 
It may be that in most instances little permanent 
benefit would result, but if we should have as satis- 
factory a proportion of cures as after tracheotomy 
in diphtheria (a modest enough hypothesis) why 
countenance the one and condemn the other pro- 
cedure? The most probable secondary result is 
emphysema, though this is not a necessary se- 
quence, and even were it so, it would be by no 
means a sufficient deterrent. 



Conclusions Begarding Dipsomania. 

The following conclusions are those given in an 
address by Dr. Gilchrist, reported in the British 
Medical Journal. 1. Dipsomania is a true neu- 
rotic disease. 2. In a very large proportion of 
cases, if not in all, it is hereditary. 3. In a large 
number of cases it is traceable to drinking habits 
in one or both parents, or connected with them in 
more remote relationships. 4. Its neurotic char- 
acter is indicated — a. By its tendency to periodi- 
city ; b. By its incurability ; c. By the loss of 
self-control over a dominant propensity in those 
subject to it; d. By the intellectual, and especi- 
ally moral, peculiarities of its victims. In the 
above chaiacteristics are seen its intimate relation- 
ship to, if not identity with, ordinary irsanity. 5. 
In its treatment there is to be recognized two es- 
sentially distinct conditions ; the neurotic pecu- 
liarity, which is permanent and irremediable, and 
the direct results from the poisoning of alcohol, 
which are temporary and remediable. 6. If the 
term "recovery" is to apply to the latter condi- 
tions only, 90 to 100 per cent, are curable. If it is 
to include the former also, 5 per cent, will be 
found a liberal allowance ; that is, not more than 
5 per cent, of the patients will be so far modified 
by any treatment as to enable them to resist, 
during the remainder of life, the propensity to 
drinking. Dipsomania, like other forms of in- 
sanity (neurotic diseases, if preferred), is a sad 
inheritance from the sins of our fathers. It is 
very rarely the result merely of vicious habits in 
the individual subject to it. If it is to be dealt 
with efl^ectually, we must extend the horizon of 
our views beyond individual cases, or even the 
present generation. "Prevention versus cure" is 
the true, if not the only, treatment. 



Conditions Necessary for Contagion to Spread. 

In a recent lecture, Dr. R. Southey, of London, 
says — 

For communicable disease to spread, three 
things are requisite : (1) an infecting poison, an 
animal cell or graft, some germ or microspore, or 
some potential fluid ; (2) some means of connec- 
tion or insertion of this poison ; (3) receptivity or 
aptitude in the person who receives this poison. 

If the atomic form of the poison is large, it may 
be believed to be heavy ; the larger, the heavier 
and more tangible it is, the less readily will it 
travel from person to person. The contagiousness 
of the disease communicated will therefore appear 
immediate or most direct ; those nearest in contact 
with the affected person will suffer most. If, 



although heavy, its vitality is great, it may be con- 
veyed about by clothes or fomites. K its vitality 
is small and it is quickly destroyed by diffusion 
through air or water, it will not travel far, and 
must be inserted quickly in a fresh body, to pro- 
voke its special reaction. 

There is much reason to think that the plague 
poison, syphilis poison, the smallpox and typhus 
poison, is of this heavy form and low vitality. 
But the poison of cholera and typhoid fever is 
probably an example of a lighter, subtler substance, 
and one of greater vitality ; since, although some- 
times carried into the body by food or water con- 
taminated by human alvine excreta, the cholera 
poison is probably also borne in the blue mists 
observed in most cholera epidemics ; and neither 
the cholera nor the typhoid poison appears to be 
destructible, although diluted in any quantity of 
cold water. The syphilis poison probably quickly 
loses its vitality or propagating powers ; once 
dried, I believe its life history is enckd. But the 
variola and varioloid poison may be dried, and, if 
neither frozen nor overheated, like mummy grain, 
it will certainly retain its infecting properties for 
years. So, too, the scarlet fever, yellow fever, 
plague, and typhus poisons can lie dormant in a 
drawer or cupboard for weeks, or months, or years, 
awaiting the conditions which shall favor future 
development. The plague is said to have broken 
out afresh after a hundred years, in consequence of 
the reopening of a plague pit. 



Idiopathic Gangrene of the Penis. 

The following interesting case was reported by 
Mr. Gay to the Pathological Society of London. 
The patient was thirty-one years old. He was a 
healthy man, free from syphilitic taint, exposed in 
his work to long walks and damp. His illness 
began with an attack of tonsillitis, which left him 
weak, and before he had recovered he was attacked 
with rheumatism in his knees and ankles, which 
passed off, and he then suffered from pain in his 
calves and feet. This also subsided in a few days, 
and he then had severe supraorbital pain, with 
oedema of the eyelids ; on the subsidence of this a 
rash appeared on the bend of both elbows, which 
faded in a few days, when he was again attacked 
with pain in the calves of the legs and swelling 
and tenderness along the external saphena vein. 
Then followed severe pain deep in the perineum, 
and in two or three days the penis became en- 
gorged with blood, tense, and rigid, and ultimately 
sloughed and separated. The superficial parts 
of the penis were oedematous, but not gangrenous. 
The man recovered. Mr. Gay considered that 
this was a case of metastatic rheumatic phlebitis, 
which ultimately led to thrombosis of the internal 
iliac veins, involving especially the prostatic and 
pudic branches, and spreading slightly into the 
external iliac vein, as was evidenced by the oedema 
of the sheath of the penis. He pointed out that 
while all the cutaneous veins of the body commu- 
nicate very freely, and in most regions the super- 
ficial and deep veins have many anastomosing 
channels, in some regions, as the penis, the venous 
channels of the skin and of the deeper parts were 
quite separate, and that when the deep veins were 
plugged the circulation could not be carried on 
through the superficial vessels, but gangrene must 



Jan. 1 8, 1879.] Reviews and Book Notices. 



59 



occur. Whether a gangrene should be dry or 
moist he considered depended upon the condition 
of the patient, and not upon the cause. 



Reviews and Book Notices. 



NOTES ON CURRENT LITERATURE. 

Of the many Guides and Seed and Plant 

Catalogues sent out by our Seedsmen and Nur- 
serymen, and that are doing so much to inform 
the people and beautify and enrich our country, 
none is so beautiful, none so instructive, as Vick^s 
Floral Guide. Its paper is the choicest, its illus- 
trations handsome, and given by the hundred, 
while its Colored Plate .is a gem. This work, al- 
though costing but five cents, is handsome enough 
for a Gift Book, or a place on the parlor table. 
Published by James Vick, Rochester, New York. 

The Archives of Dermatology, a quarterly 

journal of skin and venereal diseases, published by 
Putnam's Sons, will, on and after January 1st, 1879, 
be published by J. B. Lippincott & Co., of this 
city. 

A valuable contribution to the study of 

lacerations of the cervix uteri, is the address of 
Dr. William Goodell, at the last meeting of the 
Pennsylvania State Medical Society. It is re- 
printed in pamphlet form. 

According to Dr. Otis, of the National Medi- 
cal Library, Washington, the total number of regu- 
lar medical journals now published in the United 
States, is fifty-one. 

The Archiv der Heilkunde, an estimable 

German journal published at Leipzig has sus- 
pended, for want of support. 



BOOK NOTICES. 

* Jlodern Medical Therapeutics ; a Compendium of 
Recent Formulae and Specific Therapeutical 
Directions. From the practice of eminent con- 
temporary physicians, American and Foreign. 
By George H. Napheys, a.m., m.d., etc. Sixth 
edition, enlarged and revised. D. G, Brinton, 
Philadelphia, 115 S. Seventh St., 1879. 1 vol., 
8vo, pp. 607.. Price, cloth, $4.00 ; full leather, 
$5.00. 

No higher testimony to the value of this work 
to the medical public can be offered than the fact 
that in less than a year the previous edition of the 
book, although the fifth one, was completely ex- 
hausted. Another striking fact of the same na- 



ture is, that although the publisher has had a 
standing offer to all who buy the book by mail, 
and, colisequently, on the faith of notices and 
descriptions, to take it back and refund the 
money if it, on arrival, disappointed them, in not 
a single instance has he been requested to do so ! 

With the general plan and character of the 
book we need not occupy space. They are well 
known, from the reviews of the book in previous 
editions. Suffice it to say that in the present edi- 
tion no changes in these respects are made. The 
material of the book has, however, undergone 
extensive modification. This the editor an- 
nounces in the preface. He has what will by 
some be called the audacity to declare that 
'' Standard treatises on practice, written by men 
still living, have, in many instances, become in 
great part obsolete. Watson and Wood, Aitken 
and Tanner, no longer represent the best thera- 
peutics of the day. Their methods and their 
remedies have been largely superseded, and the 
practitioner who would keep abreast of the ad- 
vances made in his profession must look to a 
more modern class of writers for his information." 

The editor does not specifically name who these 
modern writers are, but that he has acquainted 
himself with them to some purpose, would appear 
from the fact that the Index of Authors in this 
edition contains one hundred and eighty-eight names 
of medical writers who were not quoted in the 
previous edition. They are authors of the latest 
monographs and treatises, and contributors to the 
medical periodical literature of the last two years. 
Somewhat more than half belong to English speak- 
ing countries ; the remainder are principally 
German, French, and Italian. This indicates a 
very thorough revision of the last edition, and the 
extent of the improvements which have been made 
in it. 

Various subjects are introduced which were 
omitted in the previous issue. For instance, we 
notice yellow fever is introduced, and a number 
of authors quoted, showing its treatment in South 
America, Havana, Savannah, Charleston, New 
Orleans, etc. Typhus fever, acute and chronic 
mercurial poisoning, lead poisoning, and a number 
of diseases of children, are also additions. The 
last mentioned department, that on children's dis- 
eases, has been more than doubled in size, whicK 
its importance certainly demanded. 

Irr fact, the number and variety of the changes 
in the present edition almost give it the character 
and value of a new book, and those who already 
own one of the previous issues would find the pur- 
chase of the present by no means a useless or 
superfluous outlay. 



6o 



Editorial. 



[Vol. xl. 



THE 

A WEEKLY JOUENAL, 

Issued e-very ©atixrday. 

D. G. BKINTON, m.d., Editor. 

The terms of subscription to the serial publi- 
cations of this office are as follows, payable in 
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All letters should be addressed, and all checks 
and postal orders drawn to order of 
D. G. Brinton, M.D., 

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Philadelphia, Pa. 

THE GBOUNDS OF CERTAINTY IN MEDICAL 
REASONING. 

In the discussion between Yirchow and 
Haecked, to which we alluded last week, one 
very weighty and often misunderstood subject was 
in controversy between them. 

To the statement made by Virchovt, that only 
well-ascertained facts should be taught in schools, 
Haeckel replies, derisively, " What do we know 
for certain ? Even in mathematics, the most cer- 
tain of all human knowledge, men are now dis- 
puting whether there may not be a fourth dimen- 
sion in space. What do we know of the nature 
of matter or of force ? What is there certain in 
physics and chemistry ? Why, then, is the origin 
of man a subject on which nothing should be 
taught, because it is uncertain ?" 

To this several answers suggest themselves. 
There is certainly a difference between facts and 
fancies, laws and guesses, and all that VmcHOw 
maintained was that, in schools, what are commonly 
called " known and accepted truths " should be 



taught ; and no reasonable being (Haeckel ex- 
cepted) will be likely to dispute his statement. 

But Haeckel's queries cut deeper. It might 
appear that he really means that there is no 
higher test of knowledge than belief; forgetting 
that not belief, but the impossibility of disbelief is 
the final and crucial test of knowing. A sane 
man cannot believe that twice two make five, no 
matter how much he tries. This gives its cer- 
tainty to mathematics, and all so-called " laws of 
nature " are entitled to rank as such only when 
they can receive abstract mathematical expres- 
sion. 

These discussions concern very intimately the 
science of medicine, for it busies itself wholly 
with natural laws, and it is just as essential 
to its successful prosecution that the super- 
ficial glosses of materialism and positivism be 
recognized, as that the superstitions and dogmas 
of metaphysics and supernaturalism be estimated 
at their real value. 

Professor Helmholtz, in an address "On 
Thought in Medicine," last winter, sounded the 
alarm none too soon when he said, " Our genera- 
tion has suffered under the pressure of spiritual- 
istic metaphysics ; the rising one will have to be 
on its guard against materialistic philosophy." 

Metaphysical systems have supported two lines 
of argument. According to the spirituaKstic idea, 
man may regard himself as a being of higher 
quality, towering above the rest of nature. The 
materialists consider him as unqualified master of 
the world, through the exercise of his mind upon 
the conceptions he has formed. 

But one who, like the physician, has to deal 
with the safety- or destruction-bringing powers of 
nature, has the duty, under heavy responsibility, 
of seeking a knowledge of the truth, and of the 
truth alone, regardless whether what he finds 
flatters one or other of these classes. His aim 
must be clear, and the actual result alone decisive. 
He must strive to ascertain what the consequences 
of his proceeding will be under given circum- 
stances. To acquire this power of forecast we have 
no other means than seeking, by observation, a 
knowledge of the laws of things ; and this we must 
acquire by careful search for, and study of, such 



Jan. 1 8, 1879.] 



Notes and Comments. 



61 



cases as belong to them. If we suppose that we 
have discovered a law, then commences the work 
of deduction. We must endeavor to trace its 
effects ; but also, and first, to test it by experience, 
so far as it can be tested, and ascertain when and 
in what range it holds good. This is a labor 
which should, properly, never cease. The true 
natural philosopher considers, on every strange ap- 
pearance, whether the well-proved laws of action 
of long-known powers can have undergone any 
modification ; naturally, however, there can only 
be question of such a change as does not contradict 
our stores of accumulated experience. Thus he 
never arrives at absolute truth, but only at a high 
degree of probability, which, practically, is equiva- 
lent to certainty. 

Let the metaphysicians smile ; we will take 
their derision to heart when they are able to do 
better, or even so much. On the other hand, let 
not a hasty materialism depreciate the value and 
reach of such knowledge. To a great degree it 
is more absolute than it is ever willing to concede ; 
for it is as certain as Reason, and as wide reaching 
as the Universe. 



Notes and Comments. 

Potato Eating and Diphtheria. 

Dr. M. C. Keith, of Lincoln, Neb., writes to the 
Chicago Inter- Ocean, charging much of the diph- 
theria prevalent to eating white (Irish) potatoes. 
He says — 

Some seventeen years ago the attention of my 
father. Dr. Alvan Keith, late of Augusta, Me., was 
called to the fact that children who were not fond 
of the tuber known as the Irish potatoes were not 
subject to attacks of that much-dreaded malady 
diphtheria. Following out this hint, he advised 
families of his friends to avoid the use of this veg- 
etable among the children, and until his decease 
he was accustomed to make the assertion that 
rotten potatoes produced the throat disease known 
as diphtheria. * * * * ^ * 

In my practice in this city and county the offer 
has been to treat any one free of compensation if 
they would avoid the use of Irish potatoes. As a 
sequence not one of the patients who was not a 
potato eater has been threatened with the disease. 
In many of the inland towns of this State the 
writer has patients, and in some of the infected 
districts the families of those who have learned of 



this simple preventive have escaped any attack of 
throat disease, although the potato eaters on 
either side of them have unfortunately had cases 
of diphtheria which resulted fatally. ^ * ^ ■* 
The writer rests his assertions upon a record of 
twelve years of his father's" practice prior to 
1861, and seventeen years of his own, covering a 
period of twenty-nine years, and including a per- 
sonal knowledge of 1100 cases of diphtheria. The 
tuber known as the Irish potato is specified, since 
it is believed that sweet potatoes do not have the 
effect of producing any disturbance in the human 
animal economy. If these assertions are proven, 
the result must relieve the world from a disease 
much to be dreaded, and a malady which has 
caused many heartaches upon two continents. 



Peculiarities of Inebriety. 

The Fourth Annual Eeport of the Asylum for 
Inebriates at Walnut Hill, Hartford, Conn., is an 
interesting document, and the history of the past 
year is very ably presented by the superintendent, 
Dr. T. D. Crothers. The particulars of a number 
of cases which have been under treatment are 
presented. 

Many curious facts are presented, in a history of 
these cases. Take, as an illustration, the periodic 
character of the drink-craving, which returns after 
an interval that can be definitely calculated within 
an hour ; or the insane-like madness which ignores 
everything but the gratification of its impulses ; or 
the precipitate revulsion of character and motive, 
passing swiftly from one extreme to the other ; or 
the sudden explosion of the diseased impulses, 
under conditions of excitement and change, eto. 
All these are significant of laws and forces moving 
in regular cycles as fixed and definite as that 
which governs the planets. 



The Forms of Antagonism in Drugs. 
The antagonistic action of different remedial 
agents has attracted considerable attention lately. 
Dr. Fothergill's little work on the subject is fresh, 
and has served to whet the interest of reading 
men. The same subject is treated by M. J. L. 
Prevost, in the Archives de Physiol. Normale et 
Pathol., chiefly in relation to the antagonistic pro- 
perties of atropin to muscarin. The author pro- 
ceeds to show that there are the following kinds of 
antagonisms: a. True antagonism, occurring in 
cases in which two poisons act in opposite ways 
upon one and the same anatomical element, as, for 
instance, by exciting or paralyzing a nervous 
element; b. False antagonism, when the poison- 
ous symptoms are suppressed by making use of an 
agent which renders the manifestation of the 



62 



Notes and Comments 



[Vol. xl. 



symptoms impossible ; this occurs after the injec- 
tion of curara, in a case of strychnia poisoning ; 
for the curara, paralyzing the motor or efferent 
nerves, prevents the appearance of tetanus caused 
by strychnia. Another example of false anta- 
gonism is, when two poisons act upon two different 
parts of a complicated organ ; as is the case when 
atropin and physostigmin are applied successively 
to the eye. 

Eczema Produced by Oxyurides. 
Dr. Michelson reports, in the Berliner Wochen- 
schrift, the case of a child, thirteen years old, who 
complained of itching in the inguinal region, 
which was found to be the seat of an impetiginous 
eczema marginatum, suggesting the presence of 
trichophyton. The centre of the eruption presented 
a moist surface covered with little red points, and 
with foetid debris of macerated epidermis. Micro- 
scopic examination revealed, not a vegetable para- 
site, but the eggs of the oxyuris in various stages 
of development. It is probable that the worms 
were attracted from the rectum to the parts pre- 
pared for the reception and development of their 
eggs by the heat and moisture of the eczematous 
skin. Cure was rapidly effected by warm baths 
and a lotion of salicylic acid. 



The Species of Tapeworm Now Prevalent. 

At a meeting, last month, of the Academy of 
Natural Sciences, of this city. Professor Joseph 
Leidy exhibited two specimens of tapeworm from 
the human subject. One had been submitted to 
him for examination by Dr. Levick, and the other 
by Dr. Walter Atlee. During the past fifteen 
years he had examined from two to five specimens 
yearly, sent to him by physicians who desired his 
opinion regarding the specific characters of the 
worm. It was formerly supposed that the tape- 
worm commonly found in man was taenia solium, 
the immature form of which infests the hog, and 
obtains a Jodgment in the human body by the use 
of raw or badly cooked pork. He had been sur- 
prised to find that all the specimens examined by 
him during the time mentioned belonged to an- 
other species, the taenia medio canellata, the larva 
of which is found in the cow. It is, therefore, the 
lovers of raw or rare beef who foster this form. 
This species is readily distinguished from taenia 
solium. The head is conspicuously larger, of a 
square shape and blackish color. It is provided 
with four suckers, but without the hooks so char- 
acteristic of taenia solium. There is also a striking 
difference in the joints, by means of which de- 
tached segments may be distinguished from those 
of the pork worm, the ovaries in taenia medio 



canellata being exceedingly complexand branched, 
and of a dark color, while in taenia solium they 
are comparatively few and simple, and of a lighter 
tint. Xeuckart states that the Abyssinians are 
infested with tapeworm, almost to a man, from 
their habit of eating raw beef, which they esteem a 
great delicacy. They not only eat the meat un- 
cooked, but the living animal is driven up to the 
door of their banqueting halls, and pieces of quiv- 
ering flesh are cut from it and served to the 
guests, until the poor tortured creature falls, ex- 
hausted by pain and loss of blood. These people 
do not consider the presence of the parasite a dis- 
advantage, but rather otherwise. When the 
worm grows too large, they simply cause the ex- 
pulsion of some of the segments, and allow the 
head and the remaining portions to grow again 
until they become of an inconvenient size. 



Saioide and Insanity. 

The January number of the Sanitarian contains 
a paper read by Hon. 0. H. Palmer before the 
New York Medico-legal Society, to prove that 
suicide is not an .evidence of insanity. This seems 
superfluous, as we should think none but a very 
biased person would, maintain the affirmative. 
Mr. Palmer says, in one part of his address, 
" Suicide is a pronounced sin, abhorrent to Chris- 
tianity and severely denounced in the word of 
God." We have heard it said that no direct con- 
demnation of suicide is to be found in the Bible. 
The prejudice against it, unknown in ancient 
Greece and Kome, is asserted by Schopenhauer to 
have been an emanation of the feudal system, 
wherein the life of a person belonged to his liege 
lord. 



Hints for Headaohes. 

Dr. Day says, in a late lecture : Whatever be 
the plan of treatment decided upon, rest is the first 
principle to inculcate in every severe headache. 
Kest, which the busy man and the anxious mother 
cannot obtain so long as they can manage to keep 
about, is one of the first remedies for every head- 
ache, and we should never cease to enforce it. 
The brain, when excited, as much needs quiet and 
repose as a fractured limb or an inflamed eye, and 
it is obvious that the chances of shortening the 
seizure and arresting the pain will depend on our 
power to have this carried out effectually. It is a 
practical lesson to be kept steadily in view, in that 
there may lurk behind a simple headache some 
lesion of unknown magnitude which may remain 
stationary if quietude can be maintained. 

There is a point worth attending to in the treat- 
ment of all headaches. See that the head is 



Jan. 1 8, 1879.] 



Notes and Comments, 



63 



elevated at night, and the pillow hard ; for, if it 
be soft, the head sinks into it and becomes hot, 
which with some people is enough to provoke an 
attack in the morning if sleep have been long and 
heavy. 

Effects of Chronic Starvation on the Mind, 

An English surgeon who witnessed the late 
famine in India, observes that the dullness, the 
apathy, the unfitness for labor, and the unwilling- 
ness to use the smallest exertion to better their 
condition, so often shown by the famine stricken, 
* are a part and parcel of the disease, 'chronic 
starvation,' and must in future be so regarded and 
treated." They are not to be disposed of "by 
statements of loose observers," that such people are 
idle or obstinate. 

Is is shown, by the pathological observations of 
Dr. Porter, that the nervous system shares in the 
general waste of the body. Dr. Porter's own con- 
clusions from his investigations is, " that the brain 
wastes in starvation, like other tissues of the body, 
but in a less degree ; and this atrophy of the brain 
would account for the effusion of serum into the 
arachnoid cavities and sulci of the brain, that is so 
frequently found in these cases." 



Chloral in Migraine. 

Dr. Seure, in the Bull, de Therapeutique, strongly 
recommends the administration of chloral, in an 
enema, on the occurrence of the paroxysms of 
migraine, having found it almost infallible, and 
exempt from the disadvantages attendant on other 
modes of giving this substance, and far preferable 
to the employment of morphia, quinine, etc., for 
the same purpose. He gives, according to the sex 
or robustness of the patient, from one and a half 
to three grammes, in a glass of tepid water, the 
effect of the chloral being rendered still more 
prompt by the addition of a tablespoonful of 
brandy. If a sense of burning in the rectum is 
excited, this may be prevented by adding the yolk 
of an egg or substituting tepid milk for the water. 
When, as in some persons, there is difficulty in 
retaining the enema, the quantity of the liquid 
may be diminished, and a drop or two of laudanum 
added. 



Influence of Uterine Disease on Nervous Disorders. 

A recent writer counts among the most notable 
instances of this, neuralgia supra-orbitalis, maxil- 
laris, and laryngo-bronchialis (uterine cough); also 
neuroses of the heart, causing painful palpitations, 
and spasmodic contractions of the bladder and 
bronchi (uterine asthma). All these symptoms 
become aggravated at the time of the commence- 



ment of the menstrual flow. The author observed 
one patient affected with this kind of asthma, who 
had long passed the climacteric, but whose asth- 
matic attacks were always most severe at the 
times at which the menses used to appear. Ordi- 
nary asthma also becomes worse under the influ- 
ence of uterine disease. 

Uterine affections frequently give rise to spasm 
of various muscles and to paralysis of one or both 
lower limbs. Both of these conditions usually 
come on very gradually, and they never become 
complete. 

The peripheral reflex irritation caused by ute- 
rine diseases often acts, in conjunction with other 
causes (e. g., hereditary taint, defective, nutrition, 
domestic trouble, etc.), in giving rise to mental 
disease. 



The Physiology of an Easy Chair. 

A writer in Nature sums up the "points " of an 
easy chair as follows : — 

For an easy chair to be perfect, it ought not 
only to provide for complete relaxation of the 
muscles, for flexion and consequent laxity of the 
joints, but also for the easy return of blood and 
lymph, not merely by the posture of the limbs 
themselves, but by equable support and pressure 
against as great a surface of the limbs as possible. 
Such are the theoretical demands, and these are 
fulfilled by the bamboo easy chairs manufactured 
in India, made in the shape of a straggling W, 
which the languor consequent upon a relaxing 
climate has taught the natives of India to make, 
and which the rest of the world appreciates. 



The Best Form of Mercury for Hypodermic TTse. 

Dr. E. Kirk gives, in the British Medical Journal, 
his experience on this subject while he was at 
the Edinburgh Lock Hospital ; he says — 

Six solutions were used during my term of office ; 
the bichloride with morphia ; the albuminous 
solution of the bichloride; Savory and Moore's 
lamels ; a simple aqueous solution of the bichlo- 
ride ; the biniodide ; and the bicyanide. The last 
two were soon discontinued, as possessing no per- 
ceptible advantages over the others ; but two series 
of comparative experiments with the other four 
were made with the utmost care. The first series 
was conducted to determine which produced the 
least irritation, and the patients were injected with 
all four solutions in rotation, with the result, rather 
surprising, I must admit, of showing that the 
simple aqueous solution of the bichloride, two 
grains to the ounce, produced as little irritation as 
any of the others. In the whole series of over 
three hundred injections, there was not a single 



64 



Correspondence 



[V.l. xl. 



boil, and only on rare occasions was there indura- 
tion enough to cause tenderness. The second 
series showed that the amount of mercury re- 
quired was the same, whatever solution was em- 
ployed. 

The only reasons to which I can ascribe these 
results are ; thoroughly cleansing the syringe- 
needle before each injection, and inserting the 
needle perpendicularly and deeply into the sub- 
cutaneous tissue. I believe, if these two points 
are carefully observed, that mercurial injections 
may be given with almost perfect safety, and with 
a solution so simple as an aqueous one of the 
bichloride. 



The Causes of Heat in Fever. 

As the result of some recent researches, Drs. 
Leyden and Frsenkel suggest that the increased 
formation of carbonic acid cannot alone be held 
answerable for the rise in temperature. It repre- 
sents one factor only, although one of great import- 
ance. A second factor is the altered discharge of 
heat under the influence of the cause of the 
pyrexia, the immediate mechanism of which is 
probably to be sought in a peculiar change in the 
innervation of the cutaneous and pulmonary 
vessels. Hitherto only one consequence of this 
altered vascular innervation was known — the 
rigor. Very recent experiments of Bachrach sug- 
gest another efiect : it has been found that, under 
ordinary circumstances, substances easily recog- 
nizable in the urine, as iodide of potassium, were 
absorbed far more quickly if injected under the 
skin than if administered by the mouth. In fever, 
however, the reverse is the case ; iodide appears 
in the urine far more rapidly if given by the 
stomach than if injected under the skin. 



Oleate of Zinc. 
Dr. H. E. Crocker has reported very favorably, 
in a recent number of the British Medical Journal, 
on the use of oleate of zinc in eczema. It is 
chiefly useful in the discharging stage of the acute 
and chronic forms of the disease. The preparation 
used by Dr. Crocker was made by the following 
process : One ounce, by weight, of oxide of zinc is 
stirred with eight fluid ounces of oleic acid, made 
as free as possible from palmitic acid. The mix- 
ture is allowed to stand for two Ijours, and is then 
heated until the oxide is dissolved. On cooling it 
forms a yellowish-white hard mass. An ointment 
can be made by mixing one part of the oleate with 
one part of cosmolime, or two parts of lard or 
simple ointment. When made with the two latter 
materials it quickly becomes rancid, but cosmoline 
preserves it for a long period. 



Correspondence. 



The Cause of Yellow Fever. 

Ed. Med. and Surg.. Eeporter : — 

I shall attempt to give your readers a few 
thoughts and conclusions on that all-absorbing 
question, yellow fever. It is only with the cause 
that I propose to deal in this letter. I have not 
been an eye witness to this suffering, and therefore 
must draw in part, for my conclusions, from the 
testimony of others ; however, a long familiarity 
with what I consider to be the real cause (only in 
a modified form)~gives to me, even from this re- 
mote standpoint, the privilege of drawing my own 
conclusions and asserting the same in my own 
language. Then, first, I assert that yellow fever 
is of malarial origin, and the most malignant 
of that order to which it belongs. 

The lower Mississippi, with its tributaries, in 
connection with that low, marshy region of country 
bounding it on either side^ together with its prox- 
imity to the solar rays and prolonged intensely 
hot season, all conspire with other favoring cir- 
cumstances, to supply the elements requisite for 
the propagation and elimination of this miasmatic 
poison. The fruit of this in that locality is yellow 
fever, while in this region of central western Illi- 
nois, latitude 40°, and the continuation of the 
same malarious valley, we find the more mild forms 
of the same disease, from the same cause, namely, 
congestive, remittent and intermittent fevers, 
with their numerous modifications. We do not 
believe science, with all her appliances, has by 
any means succeeded in controverting or robbing 
of its merits that old and so-called fogy theory of 
the production of malaria by the combined action 
of heat, moisture, and vegetable decomposition. If 
any new light has been shed upon this subject, it 
has certainly been that of the additional and even 
more 'poisonous effluvia emanating from animal 
decomposition. This we are willing to admit as 
being one of the factors in the cause of the 
malaria of that region, the populous cities espe- 
cially, where sewer effluvia must be profuse. 

Here we claim an argument in favor of malaria 
being a local cause of the fearful disease, yellow 
fever, also, that the mouth of the Mississippi, New 
Orleans and vicinity, is the laboratory from 
whence this disease originates. In proof of this 
we have only to consider the magnitude of the 
supply, both of animal and vegetable material, con- 
stantly accumulating and drifting into this great 
abyss, and when accumulated there, favored with 
every natural and artificial condition for rapid 
decomposition. Why doubt the above when we 
contemplate the vast extent of territory, north, 
south, east and west, settled and unsettled, fre- 
quently flooded and always drained by the tribu- 
taries of this vast river, pointing, as they do, in 
every direction, and extending from lake Itaska to 
the Gulf, and from Rocky to Allegheny moun- 
tains, gathering in their embrace every manner of 
filth, both animal and vegetable. In fact, it may 
be said every northern settlement has an outlet of 
this kind. The carcasses of many animals find a 
grave in the Mississippi, never to be withdrawn 
save by the process of decomposition, and this at 
the expense of the lives of thousands. Then why 



Jan. 1 8, 1879. J 



Correspondence, 



6j 



\ 



should we' contend that this disease is imported, 
when we possess in our very midst a laboratory 
with every natural, artificial and chemical appara- 
tus for its home production. For further proof, let 
us traverse this deep, rich and otherwise fertile 
valley, and briefly sum up these speculations. 

As' before stated, we have been prescribing at 
this point, to some extent, every season, and to a 
great extent occasionally, for all grades of malarial 
fever, from congestive to mildest intermittent, all 
susceptible, usually, of successful treatment. How- 
ever, a few degrees below this, in the same valley, 
we find a similar disease, originating from the 
same cause, but more severe, showing evidently 
greater concentration of the exciting cause. But 
at Cairo, the junction of the Ohio with the Mis- 
sissippi, some four degrees below, and where the 
low marsh lands swell into extensive swamps, wet 
and spongy, with frequent fogs, malarial disease is 
a constant' attendant. In fact, few were the sol- 
diers or officers of the late war, detained at this 
point, who did not realize by their own sufferings 
the marked increase in the force of the poison. 
Here our personal survey of this malarial valley 
terminates, but history, the topography of the 
country, and the experience of every one familiar 
with the diseases of the lower Mississippi valley, 
testify to the fact that at almost every degree as 
we descend toward the Gulf may be observed this 
increase, not only in malarial products, but its 
additional force and virulence, as shown by the 
aggravated type of the disease produced. In this 
same ratio does the cause and consequent results 
seem regularly to increase, until we arrive at the 
foot of this death-stricken valley, with its populous 
city of New Orleans, where the most fatal disease 
exists, and in our opinion is produced. Yes, we 
repeat, this seems to be the great national recep- 
tacle for all filth, pollution and putrescence ; the 
reservoir from which occasionally bursts forth and 
originates more miasmatic poison than would suffice 
to prostrate a nation of people. We shall, for the 
present, close, promising something on the subject 
of contagion in relation to the above disease. 

Alepis, III. J. P. McClanchaed, m.d. 



\ 



Acetate of Fotassa. 
Ed. Med. a^std Sueg. Kepoeter: — 

I would call the attention of the younger class 
of practitioners to this old but most excellent 
remedy. 

I take notice that a large proportion of the pro- 
fession seldom prescribe this agent. While I will 
admit it may not cure a single disease, yet I 
hold that it is a fine adjuvant in a large number^ 
both of acute and chronic diseases. Given in doses 
from ten to sixty grains, as indicated in many 
forms of disease, even with other proper remedial 
agents, it acts promptly as an excellent diuretic. 
But it may be asked, why is it better than many 
other diuretics, such as buchu, uva ursi, juniper, 
digitalis, colchicum, etc. This is a very important 
question, and I will proceed to answer. 

The kidneys perform two separate and distinct 
functions. These functions are the excretion of 
water from the blood, and removing certain nitro- 
genized matters, the product of the waste of worn- 
out tissues. The first relieves vascular turgescence, 
and the second removes matter from the blood. 



Urea forms a large amount of the solids of the 
urine, as well as uric acid, creatine, hippuric and 
lactic acid, and the soluble salts ; and when these 
elements are retained in the blood, in any form 
of disease, in suppression or retention of urine, 
set up an irritation, and probably vomiting, diar- 
rhoea, spasms, convulsions, coma, etc., are produced 
by this excrementitious matter retained in the 
blood, which should at all times be promptly re- 
moved. 

The renal hydragogues, or the common vege- 
table diuretics that I have named will only in- 
crease the fluid portions of urine, while a very 
large proportion of the solids, of the urine re- 
n^in in the system, as Dr. Krahmer has so well 
proven in his experiments. 

But we claim, by experience and observation, 
that the acetate of potassa is a renal depurant, 
when given properly, greatly increases the flow of 
urine, and particularly the solid constituents of it, 
making a splendid remedy, as an adjuvant in all 
febrile and inflammatory diseases. This alkaline 
diuretic is not only eliminative, but thus acts as a 
refrigerant. 

Acetate of potassa, when taken into the stomach, 
is absorbed into the circulation and has a direct 
affinity for the kidneys, stimulating them to in- 
creased action, and in its transit from the stomach to 
the kidneys the acetate of potassa is converted into 
carbonate, which separates the solids of the urine 
from the blood, and then both the solids and the 
urine are jointly eliminated. In sthenic fever it 
acts as an antiphlogistic ; in asthenic or typhoid 
fever it indirectly increases the strength of the 
patient by removing the materies morbi, which 
usually so depresses the vital powers. In rheu- 
matism. Dr. Golding Bird says, " I would not 
willingly use language which was not completely 
compatible with experience; but I do not still 
hesitate to declare that I have never seen the dis- 
ease in question yield with so much facility to any 
other remedy." 

The action of this remedy in chronic diseases, 
where we find an unhealthy state of the blood, 
is truly alterative, removing vitiated materials cir- 
culating in the blood, thus promoting digestion, 
assimilation and nutrition. Hence it is indicated 
in a large class of those diseases. 

I do think, from close observation, and ex- 
perience in the course of twenty years, that the 
kidneys need stimulant diuretics nearly as often 
as the bowels do cathartics. 

I treated five or six cases of dropsy the past 
year, and in every case I practiced on this plan, 
and was successful in every case ; of course I gave 
such other treatment as was indicated. I gener- 
ally prescribe the remedy in solution, giving from 
five to ten grains every four to six hours, alone or 
combined with such other remedies that are not 
incompatible, as may be indicated. 

I hope these suggestions may lead others to 
thinking. Dr. John A. Henning. 

Bedkey, Indiana, December 15th, 1878. 

— The papers think it was a little odd that 
Senator Sargent, of California, should go away to 
Florida, or Havana, or thereabout, recently, for 
his health, when his two daughters are students of 
medicine — one, in fact, graduated and practicing 
her profession at the Capital. 



66 



News and Miscellany, 



Vol. xl. 



News and Miscellany, 



state Medicine in Pennsylvania. 

The Governor of Pennsylvania says, in his mes- 
sage to the Legislature, just published — 

Among the numerous subjects that will occupy 
your attention, I beg leave to briefly emphasize a 
few that appear of more than ordinary importance. 

The establishment of a State Board of Health 
was urged in the message of 1877, and briefly re- 
ferred to in that of last year. The Medical Society 
of the State of Pennsylvania will again bring the 
matter to the attention of the Legislature. TQie 
experience of the past year has shown the deSr- 
ableness of such a department to improve the 
hygienic condition of the people and insure against 
epidemics. Second only to its police duties, if 
not, indeed a part of them, is the obligation of 
government to enforce the sanitary regulations 
necessary for the healthfulness of society. I hope 
you will not fail to give the bill presented a favor- 
able consideration. 



Extracts from the Bulletin of the Public Health, 

Issued by the Surgeon General United States 

Marine Hospital Service, for Week ended 

January 4th, 1879. 

Yellow Fever. — The present issue of the 
Bulletin is the first for which no cases or deaths 
were reported. 

Bermuda. — The United States Consul reports 
that in a population of over 15,000 there is rarely 
more than one death per week, and that the island 
is remarkably free from all infectious diseases, 

St. Petersburg. — Late advices state that the 
" plague " has reappeared on the northern shores 
of the Black Sea, where it is supposed to have 
been imported by Cossacks returning from Turkey. 
Astrachan is the central point of infection, and the 
Russian health authorities are making vigorous 
efibrts to prevent the extension of the disease. 

In England, during the past year, tents have 
been used for treatment of cases of scarlet fever and 
small pox, in towns where the diseases prevailed in 
epidemic form, with most satisfactory effect in 
arresting their spread. 



The " Index Medicus." 
It is generally known to the medical profession 
and those interested in bibliography that Dr. John 
S. Billings, Surgeon u. s. A., in charge of the 
National Medical Library, at Washington, is now 
ready to print his great " National Catalogue of 
Medical Literature," as soon as Congress grants an 
appropriation for the purpose. This indexes, 
under subjects, and by authors, books, pamphlets 
and original papers in nearly all the medical 
periodicals of the world ; including over 400,000 
subject entries, and making ten volumes royal 8vo, 
1000 pages each. This will be of the greatest value 
to physicians the world over, as it enables them to 
find analogues for peculiar and difficult cases, and 
thus often to save lives. In continuation of this 
work, it is now proposed to publish monthly, 
under the editorship of Dr. Billings and of his 
assistaiit, Dr. Robert Fletcher, m.r.c.s., a current 
medical bibliography, under the title of the Index 
Medicus. It will be issued by F. Leypoldt, the 



bibliographic publisher, 37 Park Row, J^ew York, 
at $3 per year, and will enter all medical books 
and index the leading medical journals and trans- 
actions in English and other languages. A full 
list of the latter, numbering over 600, will form a 
part of the specimen number of the Index, soon to 
be issued. 



Investigation of the Yellow Fever. 

The proceedings of the Board of Experts author- 
ized by Congress to investigate the yellow fever 
epidemic held their first meeting at Memphis, 
December 26th, 27th, and 28th. The next meet- 
ing was decided to be held at Washington, January 
15th. The following members were present : Dr. 
Bemiss, New Orleans, La. ; Dr. Chaille, New 
Orleans, La. ; Dr. Cochran, Mobile, Ala. ; Dr. 
Craft, Jackson, Miss.; Dr. Falligant, Savannah, 
Ga. ; Dr. Green, Boston, Mass. ; Mr. Hardee, 
Engineer, New Orleans ; Dr. Mitchell, Memphis, 
Tenn. ; Dr. Mosher, Albany, N. Y. ; Dr. Randle, 
Philadelphia, Pa.; Dr. Swearingen, Austin, Texas ; 
Dr. Woodworth, Washington, D. C. A thorough 
organization was effected, and the work laid out 
and assigned so as to be completed at an early day, 
in an effective manner. 



i 



Personal. 

—Dr. C. C. V. Crawford and Captain B. F.. 
Miller, of Tinicum, are candidates for Quarantine 
Master. Dr. A. W. Mathues, of Media, does not 
seek reappointment. 

— Dr. William McKenzie, of West Consho- 
hocken, has been elected President of the Mont- 
gomery County Medical Society, for 1879. 

— Dr. Frank Woodbury, of this city, has been 
appointed Assistant Editor of the Boston Medi- 
cal and Surgical Journal, and will take charge of 
its interests in this city, receive communications, 
etc. 



Obituary Kotes. 

— Dr. Peter J. Crispell died at his home, at 
Hurley, Ulster county, N. Y., December 19th, in 
the eighty-fifth year of his age. Dr. Crispell 
was born in the Town of Hurley, in the northerly 
end of the old hamlet of that name, in the house 
now occupied as the parsonage of the Reformed 
Church. He was for twenty-five years President 
of the County Medical Society. He waa always, 
until of very late years, an active politician, was 
presidential elector, and voted for Martin Van 
Buren in 1836. He subsequently became a Whig, 
and afterward a Republican. He was elected to 
the Assembly in the fall of 1848. 



MABBIAGES. 

Powell— Jarvis.— In Piqua, O., December 24th, 
1878, at the residence of tlie bride's parents, by the 
Rev. J. H. Burton, W. S. Powell, m.d., of Defiance, O. 
and Miss Libbie J. Jarvis. 



BEATHS. 

GoLBER.— In New York, on Monday, Deo. 30th» 
Valentine Mott Golder, m.d., only son of Dr. R» 
Henry and Catharine V. Golder, in the Slst year of 
bis age. 



:^^t^^^^>^^/g^ ^P^-z^^iZ^^^^ckStE. 



^ 



WHOLE No. 1143.] 



JANUARY 25, 1879. 



VOL XL No. 4. "^^ 



th: E 



MEDICAL AND SURGICAL 

REFORTlElEs 

EDITED BY D. G. ERINTON M. D. 



Terms of Subscription, FIVE DOI^IJARS per annum, in ailvanje— Single t'ojiies Ten Cents. 



OOP^TEIVITS: 



ORIGINAL DEPARTMENT. 

COMMUNICATIONS. 

Brief Hints on the Progress of Otology, for 1878— 

Diseases of the Membrana Tympani 67 

SozINSKE^ , T. S.— Premature Human Mortality. 70 
Ckotheks, T. D.— Clinical Studies of Inebriety 
—Inebriety from Sunstroke 72 

HOSPITAIi REPORTS. 

Pennsylvania Hospital— Clinic of Prof. DaCosta 
—Diagnosis and Treatment of Scurvy. Re- 
marks on Scurvy in Civil Life ; Apoplexy with 
Hemiplegia, and Syphilitic Br^iin Dis^ease. 
Rapid Recovery Under Iodide of Potassium... 75 

EDITORIAL DEPARTMENT. |^ 

PERISCOPE. V|§. 

Experiments in Transfusion 79 

The Nature and Treatment of Acne 79 

The Skin in Tinea Tonsurans 79 

The Diet of the Gouty 80 

TheEthylates of Sodium and Potassium 80 



REVIEWS AND BOOK NOTICES. 

Notes on Current Literature 

BOOK NOTICES. 

The Science and Practice of Surgery (Gant). 

editorial. 
The Contagion of Tuberculosis 



81 



KOTKS AND (OMMENTS. 

M'^llu-'Cnm Comauio um.... 

The Tr ;. tiiieiit of l.nn .<;. 

Stretciiiiig th.' l-ncial Nei ve Jbr ( 'onvulsive T c. 

Py o-allic Acid ill H{riii()i)'ysis 

The ' roloi ged I'aily U.><e oT S..licvlic Acid 

Tlir Microphone in Diag o-i 

Successes (,f Airi.sipt:c .Surg-iy 

The Quinine Rash 

CORRF.S! "ON HENCE. 
The Value of Clil )riile mi Di, h h riadl. V W).. 

Instruiri.rits in L <Uo (Sigs')et'j 

On ihe Use of D xtio Quioiio- iN ici<e,son) 

'J he IntroUuc ion oi YtMh>\v e^er (Ivilpairi k). 
A Ca,-e of Eiysipe.as c \ rti)d"rbtr-ck 

NKWS AND MIS^KLLANY. 

B • Wii re o f I m pos tors .v^. , > ;., 

Not. s on JNovei I^iiaimaceut c il Frejiiii rat ions — 
C'opai vie Acid ; Clilo. ai-Clitorofoi ni ; Malnnie. 

Mtdical L'liarit ies of Flniaeielpliia 

Death of Dr John B. Bidd e , 

A. vv . Lnecli, M i) 

IVl^d ime Aiiderso I's Walk 

Frevalei ce of Diphtheria , 

Oije Hundred and Two Yevrs Old 

Itt-ms 

Quekies AND Replies 88 

Makri AGi:s AND Deaths 88 




Established in 1853, by S. W. BUTLER, M. ]|| ^ 

PHILADELPniA: 
Published at No. 115 South Seventh Street. 

JAMES A. MOORE. Printkr, 1222 and 1224 .Sansom Street, Ph/labelpuia. 




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Ferguson, 'P. 1. VVhitten, K. A. M'lllaM, Mr. W. T. 
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dick, A. M. Jt>nes. I-)toi.- Drs E. K Hjiilej', A. J. 
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thews. Kew Ynrk —Drs. M C. v\'est, K. tsteige'-, P. 
T. Heartt, K. R. Henllev, W. W. .-.nutli, A. I'oin- 
stock. P. A. Hayes, A. P. laoks>n. K. K. G )vv. .NL 
G. R^t» flp, Loudon Mamifacturing Company. 
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H. Hunt, H A. R xiebuifih, ^. K. S^Hn!on, T. 1 1. 
Moore, N. B. Rldsew y. \V \V. Fierce, H. A. sev- 
erHij.-e, W. W. P. nnell D. R. S Ivt^r, li-lter A 
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i'm.~Dr. ]> Newcouii). OFFICE P.WMF.NTs.— 
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Lindsay .t Blaki-to.., Kuss 1 & Nf wbnry, Ciaxton, 
Remsen & tl arte Hi age r, J. k. Lippmcott & Co. 



WTETE'S 

DIALYSED IRON. 



(PEEEUM D[ALTSATUM.) 



A Pure Neutral Solution of Peroxide of Iron in the 

Colloid Form. The Besult of Endosmosis 

and Diffusion with Distilled W&ter. 

PREPARED SOLELY BY 

JOHN WYETH & BRO., 

PHILADELPHIA. 



This article possesses great advantages over every 
otlier ferru.diious preparation lieretofore Intro- 
dn.ced, as it is a solution of iron in a.>< nearly as pos- 
sible the form in which it exists In the blood. It 18 
a preparatloQ of invariable strength and purity, 
obtained by a process of dialysaiion, the Iron being 
separated from its combinations by endosmosis, 
according to the law of dilfusioa of liquids. It has 
no styptic taste, does noi blacken the teeth, disturb 
the stomach, or constipate the bowels. 

It affords, therefore, the very best mode of admin- 
istering 



iRoisr 




The Coiiibiiiatiou wliidi all Forms of Iron 
must assume betorc Assimilation. 



Superior to all other Iron Salts in that, while 
it is readily taken into the circulation, and 
does referruginate the blood, it does not 
ordinarily cause constipation nor headache. 
It is-ii^erjy ,pleasant to the taste, and is un- 
alt^dbh: j 

Ferrous Chloride is a neutral salt, consequently it 
has no action upon the teeth, an«l may be admin- 
istered fearlessly. This fact and the delightful taste 
of my preparation render it an advantageous form 
for administration to children. Each fluid drachm 
contains one grain of Ferrous Chloride, which, 
owing to the certainty of its assimilation, is a full, 
active, adult dose. 

McKELWAY, Apothecary, 

Successor to O. S. HUB BELL. 

1410 OHESTNUT ST., PHILADELPHIA. 



in cases where the use of this remedy is indicated. 

The advantages claimed for tills form of Iron are 
due to the absence ol free acid, wliich is dependent 
upon the perfect dialysatlon of the solution. The 
samples of German, French and American Liquor 
Ferri Oxidi L'ialys. wiiieii we have examined give 
acid reaction to test paper. If tbe dialjsation is 
continued sufficiently long, it should be tusteiebS 
and neutral. 

Ourdialysefl Iron is not a saline compound, and 
is easily distinguished from Salts of Iron, by not 
giving rise to a blooi-red color on Alie addition of 
an Alkaline Sulpho-Cyanide, or a blue precipitate 
I with Ferro-Cyanide of Potassium. It does not be- 
come cloudy when boiled. When agitaied with 
one part of Alcoliol and two parts of Ether (fortior), 
the Ether layer is not made yellow. 

Physicians and Apothf canes will appreciate how 
important is the fact that, as an antidote forPoison- 
ng by Arsenic, Dia^ysed Iron is quite as eiHclent 
« the Hydraled Sesquioxide (hitherto tlie best 
remedy known in such cabes), and has the great 
advantage of being always ready for immediate use. 
It will now doubtless be lound in every drug store, 
to supply such an emergency. 

Full directions accompany each bottle. 

Physicians will find our DIALYSED IRON in all 
the leading drug stores in the United States and 
Canada. 

It Is put up in bottles retailing for OXE DOI.I<ii.R« 
containing sufficient for four months' treatment 
Large size Is Intended for hospitals and dispensing* 
Retail at $1.50. Price Lists, etc., senton application. 

jOHi mm k m. 



THE 



MEDICAL AND SURGICAL REPORTER. 



No. 1143.] 



PHILADELPHIA, JAN. 25, 1879. 



[Vol. XL.-No. 4. 



Original Department. 



Communications. 

bkief hints on the progeess of 
otology, for 1878. 

{Concluded from p. 49.) 
Diseases of the Membrana Tympani. 

All your readers are no doubt aware there are 
three layers in the membrana tympani, or external 
drumhead, viz., the outermost or dermoid layer, 
covered with the epidermis of the skin, the middle 
or fibrous layer, or membrana propria, and the 
internal layer, which is also covered with mucous 
membrane and epithelium. It was for a long 
time taught and published that all the blood 
vessels of the membrana tympani were to be 
found, on the one side in the continuation of the 
cutis only, and on the other side in the mucous 
membrane of the tympanum. More recent and 
cai-eful investigations have been made by Kessel,^ 
in which he states, " The results of my investiga- 
tions show that nerves, blood and lymph vessels 
exist in the three chief layers of the membrana 
tympani, in the cutis, the membrana propria, and 
the mucous membrane." We see no mention of 
these investigations in the recent treatise of Dr 
Burnett.f 

These careful experiments have been confirmed : 
see a recent paper " On the Blood-vessels and the 
Circulation in the Membrana Tympani and Manu- 
brium Mallei." A series of investigations by Pro- 
fessor S. Moos, J of Heidelberg, with beautiful plates. 

* See Strieker, " Manual of Histology," p. 968. See, 
also, on the Nerves and Lymphatics of tlie Mem- 
brana Tympani, Med. CentralbUiU, No. 2;^, 24, 1869. 

t"A Treatise on the Ear." H. C. Lea, Philadel- 
phia, 1877. 

X "Archives Ophthalmology and Otology,'' opt. 
clt., p. 87 J. 

67 



The Professor was led to make these researches by 
finding blood-vessels in the substantia proi)ria, 
in the case of a child, close to the mannbriam of 
both membranse tympani, which had been re- 
garded at first, by him, as pathological ; but subse- 
quent investigations proved them to be a normal, 
and not a pathological condition. 

This study of the membrana tympani is a sub- 
ject which is worthy of the closest attention, and 
those who teach must themselves be well taught. 
At the present day the tendency is for men with 
but little experience and a superficial knowledge 
of a subject to rush into print in the form of 
books, for the instruction of, not only students, but 
practitioners older than themselves, and in some 
instances, able, by experience, to teach them. In a 
recent work,"^ which is admirably illustrated, there 
is also given a good description of the anatomy and 
physiology of the ear, with acou^ic physiology, 
most of it condensed from recent German works, 
and a ferw hints from the author's own experi- 
ments, in confirmation of previous known facts. In 
the second part there is a description of the various 
instruments and apparatus, with an account of sound 
and hearing ; but the author has omitted one of the 
most important of all the subjects in diagnosis, 
namely, "the characteristic appearances of the 
membrana tympani, its position, polish, thickness, 
mobility and light reflex, etc., on inspection. Also, 
no mention is made with regard to the auscultation 
of the ear, nor a description of the sounds to be dis- 
tinguished on inflation. The whole chapter on 
examination of the ear requires careful revision^ 
for not a word is said of the use of the forehead 
mirror in examining the deeper parts of the ear. 
In the section relating to chronic catarrhal inflam- 
mation of the midrUe ear there is not the slight- 
♦ Burnett on the Ear, opt. cit. 



68 



Communications. 



\Yo\.x\ 



est reference to the subject of prognosis. This 
is a subject requiring long years of experience 
and the treatment of a large number of cases care- 
fully recorded. 

Among the more recent contributions to oto- 
logical literature, in book form, is a work which 
claims our attention and that of many who desire 
to make a careful study of, and want to arrive at a 
correct diagnosis concerning, diseases of the ear. It 
is an " Atlas of Diseases of the Membrana Tym- 
pani," by H. Macnaughton Jones, m.d. m. ch. 
F.R.C.S.I., Surgeon to the Cork Ophthalmic and 
Aural Hospital.* This is a quarto of 8 plates, with 
63 figures drawn with great care, lithographed, 
and sold at a moderate sura. The author states 
that he has chosen for delineation only such cases 
iis might furnish truthful representations of morbid 
states occurring continually, and which may at any 
time come under the notice of the practitioner, 
and aid him in diagnosing affections of the ear. 
The work has no pretensions to being a complete 
■one, but in the drawings of the membranes, etc., 
the particular ones selected cover a large field in 
otological work. 

These illustrations are not quite equal to those 
produced by Mr. Hinton, published in 1874, which 
consisted of an edition of only one hundred and 
sixty copies ; the drawings were all water colors and 
by hand, costing five or six times the price of the 
present series, which fact diminished much of their 
usefulness. Neither are they as well executed as 
those of Dr. Adam Politzer, " The Membrana Tym- 
pani in Health and Disease," and twenty-four 
chromo-lithographs, prepared by himself and sent 
to this country, and published in 1869 ; but Dr. 
Jones' illustrations are superior in care, finish, 
and number of illustrations (being 63), to any 
others we have seen in this country. No practi- 
tioner can conscientiously undertake to diagnosti- 
cate the nature, extent, and character of aural 
affections without a knowledge of these various 
appearances of the membrana tympani, as it re- 
quires a familiar hand, a trained eye, and previ- 
ous knowledge of what you are to look for. The 
fall notes which are appended, and the appear- 
ances of a variety of conditions, will aid very 
much, even the practitioner, in being able to come 
to a satisfactory and correct diagnosis in many 
obscure affections of the ear. 

We would recommend all who are desirous of 
treating diseases of the ear to obtain a copy of this 
bea itiful and useful work, as, in conjunction with 
a general work, he may so fit himself as to treat 
knowingly and successfully most of the affections 
of the ear. 

* Lindsay & Blakiston, Philadelphia. 



Otitis Intermittens, and Otalgia Intermittens. 
In the year 1871, Dr. Frederick E. Weber* 
described this form of otitis by relating the case 
of Dr. Harden, of Berlin, one of a number of 
cases of this disease. " It commenced September 
10th, late in the afternoon, after a walk of one and 
a half hours' duration in very windy weather, with 
a singing, and immediately afterward buzzing 
noise, the sensation of obstruction and a diminu- 
tion of hearing in the right ear. A slight nasal 
and pharyngeal catarrh, of a week's standing, 
induced the supposition of a transition of this 
condition through the Eustachian tube, associated 
with chilliness, headache, vertigo, extreme sensa- 
tion of fatigue, gnawing pain and pulsating 
noises, and from eleven o'clock p.m. various bor- 
ing, beating, and sometimes pressing pains, 
radiating toward the right eye, the inferior 
maxilla and the shoulder, with painful sensations 
when closing the mouth firmly or opening it wide, 
which continued until nine a.m. next day. These 
symptoms, with stiffness of the neck, slight rigors 
for several evenings in succession, with marked 
inclination to perspire when in bed, continued 
until the 18th, when patient could leave his room 
and walk about, but with considerable diminu- 
tion of hearing. The speculum showed hyper- 
semia of the external meatus and slight injection 
of the membrana tympani. The introduction of 
the Eustachian catheter repeatedly, air douche, 
with the use of iodide of potassium externally 
and internally, and the removal of a small 
quantity of tenacio-is turbid fluid, by aspira- 
tion through the catheter, caused an increased 
resonance of the patient's voice, a sensation 
of relief and marked increase of hearing. This 
process was repeated on the 25th ; but as the 
improvement obtained was only transient, the 
membrana tympanum was perforated and a small 
quantity of muco-purulent fluid removed. This 
treatment was repeated without any materialim- 
provement of hearing, even after the catarrhal 
symptoms had disappeared. 

On October 9th, after a walk of one and a half 
hours' duration, moderate pains again occurred in 
the ear, with pulsating noises ; chilliness, loss of 
appetite and insipid taste set in, and after going 
to bed a sensation of oppression about the chest, 
with chilly sensations, gave way to a light 
fever and moderate, but marked general per- 
spiration afterward. Next day, with the excep- 
tion of abnormal sensation in, and general hyper- 
sesthesia of, the ear, the patient was well enough. 
Toward night a repetition of yesterday's symp- 

• Monatsschrift fiir Ohrenheilkunde, November 
1871. 



Jan. 25, 1 879. J 



Communications. 



69 



toms. The 11th and 12th presented the same 
occurrences as the two previous days. Quinine, 
in full doses, taken late on the 12th, prevented a 
return of the same symptoms next day. It was 
repeated on the two following days, and it caused 
a cessation of all abnormal sensations about the 
affected ear, and on the 18th the cavity of the 
tympanum was free from secretion, and the hear- 
ing almost entirely restored. This, with the 
other cases recorded by Dr. Weber, are proof of 
views formerly expressed by us, to the effect that 
many lesions considered to be middle ear catarrhs 
are referable to primary affections of the presiding 
nerves and malarious influences. 

These observations were confirmed by us in 
numerous instances in our practice, especially in 
patients from the south and southwest, and the 
following case was reported by him :* — 

Case 1. — ^^Intermittent Otitis." Miss M. H., 
aged 21, Green street, Philadelphia, daughter of 
wealthy parents, fair, delicate skin, small in 
itature, and not robust. She is the eldest child, 
has had what the mother calls a running from left 
ear for a^ong time, and has been under the care 
of four different physicians. The running would 
cease for a time, but after exposure would return. 
She came under the writer's care in January, 1871, 
and continued under careful and constant treat- 
ment until July, when she was discharged well, 
and has continued so up to this date. 

The following were her symptoms and the 
condition of the ears. On examination the surface 
of the meatus was found studded with minute 
abscesses, some of them open, others in a swollen 
state with apices containing a minute portion of 
pus. If they were large they gave her consider- 
able pain, until, discharging, they left the meatus 
slightly red and swollen. The membrana, tym- 
pani of the left ear was opaque, of the right 
normal. Hearing distance for low ticking watch 
on left side only -^^] right side |§. Discharge 
stains the pillow, and has some odor which is very 
annoying to the patient. Finding some slight 
dullness on percussion under one of the clavicles, 
and also being informed that cod-liver oil had 
checked the discharge, I recommended its con- 
tinuance with extract of malt, nourishing animal 
diet with occasional use of iodide of iron in pills, 
directing a wash of sulphate of zinc, glycerin, and 
carbolic acid, with the use of Politzer's air douche. 
In three weeks the hearing distance improved to 
/^, but no decrease in the discharge. She com- 
plained of more pain, therefore directed morphia 
to be added to the zinc injection, employing 
Clark's ear douche twice a day to wash out the 



I 



* Trans. Penn. State Med. Society, 1872. 



meatus, which duty was carefully attended to by her 
mother. February 28th, no discharge for several 
days. Found the cod-liver oil was disturbing the 
stomach ; directed small doses of strychnia with 
compound syrup of hypophosphites and sherry 
wine. This she took for some time with great 
advantage. She continued about the same durinij 
the months of March and April, at the end of 
which time she went to Annapolis, Maryland, a 
place she had been accustomed to visit for several 
years. On her return she had a slight chill every 
second day and an increase in the discharge from 
the ear. I at once took the hint, and gave her 
full doses of quinine, with entire relief to the chills. 
and also checking the otitis. The hearing of tlie 
left ear was not so good as that of the opposite one. 

Another acute case recently occurred at the 
aural clinic of Jefferson College Hospital, and the 
following is a brief extract from the record book r 
January 11th ; D. M. W., aged twenty-four, was 
attacked with malarious fever, with some symp- 
toms of continued fever, such as chilliness wirh 
free perspiration, followed by debility. The ear of 
the left side was then attacked with pain of a most 
distressing character, which was partially relieved 
by the discharge of two furunculous abscesses. 
The use of mass hydrargyrum, dilute acids and large 
doses of quinine relieved these symptoms. He 
then applied at the aural clinic for relief of the 
deafness, as his hearing distance was only six 
inches for a twenty-inch watch. The meatus wHvS 
found inflamed, swollen, and the points where the 
abscesses had discharged were still seen. The 
membrana tympani was hypersemic and slightly 
drawn inward; the inflammation was chieHy 
around its edges. This state of things had exibted 
for one week. He was directed to continue quinire, 
with the use of Politzer's air douche, and by the 
13th of January he was able to resume his duties 
as one of the clinical clerks ; hearing much im- 
proved, and icteroid color of the skin almost gone. 

These observations have been confirmed by 
Voltolini* who has described several cases of ear 
disease which showed a similar intermittent char- 
acter, and which were only relieved by quinine ; 
he advises its use for a long time, but not in large 
doses. Both the "otitis intermittens and otal 11 
intermittens" were referred by Weber- Lielf to ma- 
larial neuralgia of the third branch of the fifth or 
trificial nerves, the otalgia being a malarial neu- 
ralgia, pure and simple. The otitis being an in- 
flammatory affection, the expression of a vaso- 

• Monatsschrift fiir Ohrenheilkunde. No. 5 and 
No. 7, 1878. 

tibid. No. 5, 1878. Boston Med, and Surg. Jour- 
nal, Jan. 2, 1879. 



7° 



Ct mmunications. 



[Vol xl. 



motor trophic neurosis accompanying or pro- 
duced by the neuralgic affection. I have noticed 
tliis same condition in " tinnitus aurium," also in 
furuncles of the ear, which no treatment relieved 
until the patient had taken full doses of quinine, 
with wine and nourishing diet, and this has been 
confirmed by Weber-Liel, who states that " neither 
the air douche, warm or cold applications, or mor- 
phine injections, prevent the recurrence of the 
nightly pains." In one case treated by the 
writer half a grain of morphia did not relieve the 
pain, when a large dose of quinine had the de- 
sired effect. How will it be now with those gen- 
tlemen who state that the quinine must be given 
up? Is quinine the cause of increasing catarrhal 
deafness, when so many good authorities state its 
great value in just such cases? In acute "Me- 
niere's disease" quinine is our sheet anchor, and 
" Charcot " and others have seen good results from 
its use in large and repeated doses. Although in 
this latter disease, which primarily affects the 
labyrinth, the deafness is incurable, still the brain 
and I he life of the patient was saved by the use of 
the quinine. 

Another valuable contribution to the "aural 
student," and, indeed, to all who see and treat dis- 
eases of the ear, is " the Pathological Anatomy of 
the Ear," by Hermann Schwartze, m.d.. Profes- 
sor in the University of Halle.* This admirable 
translation constitutes the sixth part of Kleb's 
"Handbook of Pathological Anatomy." It is 
^sentially a handbook on the subject of which it 
treats, a small amount of space often sufficing to 
give the results of researches the laboriousness of 
which can only be appreciated by those who have 
been engaged in similar work. " The translation is 
issued both to show what has already been accom- 
plished in this branch of otology, and with the 
hope of directing still further attention to patho- 
logical anatomy, the only solid foundation for a still 
further advance in our knowledge of diseases of the 
ear." Extract from translator's preface. Joseph 
Toynbee, of London, was the founder of the patho- 
logical anatomy of the ear, and his descriptive 
catalo ^ue t of his (836) preparations in his museum, 
now in Hunter's Musuem of the College of Sur- 
geons of London, is worthy of a visit from every 
student in this department. The only single large 
public collection of pathological preparations of 
the ear in Germany is stated to be found in the 
Patho ogical Institute of Leipzig, where it was 
formed by the late " Wendt," and placed under 
the care of Prof. E. Wagner. To show the thor- 

•Translated by I. O.ne Green, A.M. M.D. Boston, 
18 8, pp. 174. 
t-LouUou, John Churchill, 1857, pp. 127 



ough character of the work of Prof. Schwartze, he 
says, " Where the stated facts are not derived from 
personal observation and investigation, the result 
of nearly twenty years' experience in the anatomi- 
cal and practical study of the human ear, the nam© 
of my authority is given in brackets." 



PKEMATUEE HUMAN MORTALITY. 

BY T. S. SOZINSKEY, M.D., PH.D., 
Of Philadelphia. 

In looking over some mortality statistics, whicft 
I had occasion to do recently, I was greatly im- 
pressed by the proportion of premature deaths. 
It is a painful subject to contemplate, but a very 
important one ; for the welfare of the human race, 
the conservation of human life, is, or ought to be, the 
end and aim of almost all united efforts, social and 
governmental, as well as tlie labors, physical and 
mental, of every one. In this condensed article 
I propose to lay before the reader some facts in 
regard to the premature mortality in the United 
States as a whole, and in the city of Philadelphia, 
with a few remarks on the possibility of tessening 
it. 

Now, in order to fully appreciate the facts to b« 
given bearing on the mortality of the young, it 
will be necessary, first, to form something like a 
definite idea as to the naturallimit of human life. I 
say natural, because no one surely can believe for a 
moment that persons who die at one, or five, or 
ten, or even fifty years of age die, properly speak- 
ing, natural deaths. Every man and woman 
should live, not to the average age of the whole 
population, but to the full age of the oldest. If 
all were equally perfect in constitution, to begin 
with, and were to lead similar lives under similar 
circumstances, this would undoubtedly be the 
case. Every one, however, of sound constitution 
at birth, who leads a life fairly in accordance 
with the laws of health, should live close on, if 
not actually to, the age of the oldest. Nearly all 
die within the limit of po.^sible longevity, or, as 
Dr. Rush puts it, " Few persons appear to die of 
old age." People live, individually, a length of 
time which merely approximates more or less 
closely the period which they severally ought and 
would if they were free from inherited taints, and 
the conditions were favorable and properly re- 
garded. 

King David placed " the days of our yeare " at 
threescore and ten years, with a possibility of reach- 
ing fourscore ; and Ecclesiasticus, who, judging from 
his writings, was a physician, says : " The number 
of a man's days at the most are an hundred years." 
M. Fleurens, after prolonged investigation, cam* 



Jan. 25, 1879 



Communications, 



71 



to the conclusion that a century is the natural 
limit of human life. The natural lon«?evity of 
ever}^ species of animal he places at five times the 
period required f »r it to arrive at maturity. He 
thus formulates the law in the case of man ; " man 
being tweutv years in growing, lives five times 
twenty, that is a hundred years." Notwithstand- 
ing the opinion of a few scientific men to the con- 
trary, I believe it is certain that some live to and 
even beyond a hundred years. A writer who has 
given close attention to the subject comes to the 
conclusion that of all deaths in the tTnited States 
yearly five hundred are of centenarians. In the 
Census Report of 1870, 941 deaths are recorded as 
having occurred in persons between 90 and 95 
years of age ; and 565 in persons over 95. During 
the year 1876 there difd in the city of Philadel- 
phia, according to the report of the Board of 
Health, 12 persons aged from 100 to 110. It is 
safe to put down the possible age of man at a 
hundred years. 

From the data given in the volume on mortality, 
of the United States Census Eeport for the year 
1870, I have ciphered out the following interesting 
tables ; — 

The whole number of deaths, 492,263. 

Miles, 260,673. 

Females, 231,590. 

THE PERCENTAGE OF DEATHS OF EITHER SEX AT 
VARIOUS AGES. 



MALES. 

Percentage 
Aie. of Deaths. 

Under 5 42.01 

5—10 5.26 

10—15 3.14 

15—20 3.62 

20—25 4.80 

25—30 4.11 

30—35 3.63 

35—40 3.91 



3.67 

3.66 

3.65 

3.00 

3.47 

3.13 

3.02 

2.29 

80—85 1.85 

85—90 0.84 

90—95 0.36 

95 and over 0.21 

Not given 0.34 



40—45. 
45—50. 
50—55; 
55—60. 
60—65. 
65—70. 
70—75. 
75—80. 



FEMALES. 

Percentage 
.\ge. of Deaths. 

Under 5 40.48 



5—10 .. 


5.44 


10—15 


3.36 


15—20 


4.63 


20-25 


5.80 


25—30 


4.13 


30—35 


4.35 


35—40 


4.27 


40-45 


3.57 


45—50 


2.84 


50—55 


2.85 


55—60 


2.34 


60-65 


2.94 


65—70 


2.71 



70—75 2.90 

75—80 2.42 

80—85 2.05 

85—90.., 1.00 

90—95 0.45 

95 and over 0.32 

Not given 0.15 

The number of deaths here given for 1870 was 
equal to 1.28 per cent, of the population. In 1860 
the death rate was 1.25, and in 1850 it was 1.39 
per cent, of the population at the time. If all the 
deaths were reported, the mortality at any of these 
periods was much less than it generally is elsewhere. 
The death rate in England in 1876 was 2.121 ; 



in Scotland 2.1 ; and in Ireland 1.74 per cent, of 
the population. According to the most accurate 
statistics obtainable, the annual mortality of all 
Europe is 2.38 per cent, of the population. In the 
city of Philadelphia the deaths during 1876 were 
equal to 2.283 per cent, of the population. 

I may remark that the tables just given are very 
interesting as showing the relative mortality of the 
sexes at different ages. It will be seen that 1.53 
per cent, more males than females die under five 
years ; that under 15 years 50.41 per cent, of 
males and 49.28 of females die, a difiference of only 
1.13 per cent ; that from 15 to 40 years 20.07 per 
cent, of males and 24.18 of females die, a difference 
of 4.11 percent.; and that 29.15 per cent, of the 
deaths of males are of persons over 40 years, and 
of these 3.26 per cent, are over 80 years, while 
26.39 per cent, of the deaths of females are of per- 
sons over 40 years, and of these 3.82 are over 80 
years, and so on. 

From the annual report of the Health OflScer of 
the City of Philadelphia for 1876, I obtain the fol- 
lowing table : — 

Percentage 
Age of Deaths. 

Under 1 year 24.08 

1-2 7.89 

2-5 8.41 

5-10 3.99 

10-15 1.63 

15-20 3.39 

20-30 9 87 

30-40 9.64 

40-50 8.31 

50-60 6.64 

60-70 6.73 

70-80 5.82 

80-90 2.88 

90-100 0.56 

100-110 0.06 

The death rate at different ages, as indicated by 
the above national and local tables, reveal an ap- 
pallingly large percentage of premature deaths. 
The statistics of Philadelphia may be taken as 
correct; those of the nation at large are only ap- 
proximately so. Confining my attention to the 
record in Philadelphia, I notice that over 40.38 
per cent of all deaths are of children under five 
years ; 44.37 are of children under. 10 years ; 
49.39 are of persons under 20 years ; 77.21 are of 
persons under 50 years; 96.40 are of persons 
under 80 years ; and only 3.50 are of persons over 
80 years. These figures speak volumes. They 
indicate that the human race is in a rather degen- 
erate state ; that it is struggling hard for existence. 
Less than a half of all born live to maturity, and 
nearly all are sufferers. How many appear in 
this world to wage constantly a war for existence 
against the irresistible forces of nature ! Within 
their frames the majority of the species bring with 



72 



Comn: unications. 



|Vo1. x1. 



them into being what puts them in deadly con- 
flict with nature's laws ; indeed, the soundest are 
constantly contending with her subtle and al- 
mighty forces. Even though we are free from taints 
of all kinds, and regulate our regimen or mode of 
life as thoroughly as possible, we are frequently, 
nay always, pressed upon to a degree. Could man 
place himself in harmony with the laws of nature, 
there would be no suffering, there would be no 
premature deaths, except, of course, from direct 
injury. 

The proportion of premature deaths at pres- 
ent is unnecessarily large ; it is possible to 
lessen it considerably. In the edition of 1876, of 
Carpenter's Physiology, I find the following re- 
marks: "The difference in the annual rates of 
mortality between the most healthy and the most 
unhealthy localities in England, amounting to no 
less than 34 in a thousand, is almost entirely due 
to zymotic diseases, which might be nearly, if not 
completely, exterminated by well-directed sani- 
tary arrangements. The lowest actual mortality 
is 11 per thousand, while the highest is 45 per 
thousand. The average mortality of all England 
in ordinary years is about 22 per thousand, or just 
double that to which it might be reduced." 
Similar remarks might be made about the 
mortality from zymotic diseases in this as 
well as in any other country. Doubtless, these, 
as well as many other diseases, would be 
far less frequent and fatal than they are 
if the race were sounder and stronger than it is. 
The physical improvement of mankind individu- 
ally would do more than anything else to lessen 
the number of premature deaths from any and all 
causes. Nor is it irrational to hope for a great 
improvement in the human physique. The origin, 
growth, and health of man are subject to natural 
laws, which are reasonably well understood, and 
to some extent amenable to human control. Does 
it not follow that human culture is an art with a 
gcientific basis ? The human species can surely be 
cultivated with something like as great success as 
can any other animal species. From healthy, 
strong parents one can look with confidence for 
healthy, strong children ; and with a due observ- 
ance of the laws of health, bodily and mental, 
thij should live until cut off by old age. And in 
speaking of the laws of health, nothing very in- 
taigible is referred to. They bear on the relations 
of life to food, air exercise, rest and temperature. 
With food proper in amount and quality, with air 
free from impurities, with the requisite amount 
and right kind of exercise of body and mind, with 
regular hours of rest, and with a temperature duly 
regulated by clothing and shelter, there is no 



reason in the world why all mankind, if healthy at 
birth, should not live and flourish for eighty, or 
even a hundred, years. 

CLINICAL STUDIES OF INEBRIETY. 

BY T. D. CROTHERS, M.D., 

Superintendent, Walnut Hill, Hartford, Conn. 
Inebriety from Sunstroke. 

The more familiar we become with the early 
history Of Inebriety, the more numerous the special 
exciting causes appear. In nearly every case we 
can distinguish some special event or circum- 
stance which has developed or given shape and 
direction to a long train of diseased tendencies, 
ending in inebriety. 

Conditions of profound exhaustion that are sud- 
den and prolonged often react in an uncontrollable 
desire for food, or fluids relieve this state. Such 
instances are commonly seen in persons who suffer 
from sudden and powerful emotional disturbances — 
such as fear, anger, grief, joy — or in those deprived 
of food for a long time. Men on "Wall street" 
exhibit this in the ravenous eating and drinking 
after any special excitement, and many poor 
soldiers reduced to starvation in Southern prisons 
died on their return, from over indulgence, stimu- 
lated by an impulsive appetite which they were 
powerless to control. 

Many instances are noted of inebriety originat- 
ing from eating to excess, or drinking ice water in 
certain conditions. The derangement and shock 
to the system from these causes react in exhaus- 
tion and impulsive demands for relief. 

The congestion and obscure changes from sun- 
stroke, in the brain and nerve centres, are some- 
times manifest in this way. If alcohol is given at 
this time it may fix the deranged functional 
activities, and bring on new pathological condi- 
tions, of which inebriety may be either the symp- 
tom or the disease. The disordered and suspended 
brain activities from the action of the heart in 
sunstroke are commonly followed by various 
physical and psychical symptoms, which in many 
cases are severe and protracted. 

The action of alcohol at this time is marked by 
an unusual susceptibility to its poisonous effects. 
We have studied a number of cases of inebriety 
which apparently dated from sunstroke, and by 
grouping them the following divisions or classes 
seem to follow from their history. 

First, those cases of sunstroke from which many 
complex physical and psychical symptoms follow, 
attended with anaemia and exhaustion, where 
alcohol given medicinally acted as an exciting 
cause, rapidly producing inebriety. 



Jan. 25, 1879.] 



Communications, 



73 



[ 



In the second class we are able to trace some 
special condition which antedated and probably- 
acted as an ex iting cause for the sunstroke, and 
at the same time indicated a deranged nutrient 
centre, or functional gastric disturbances which 
would naturally end in inebriety or some similar 
disorder. 

In the third class the symptoms are largely 
psychical, and give no intimation of mental dis- 
order. Inebriety here appears unexpectedly, and 
is attended with great prostration, etc. 

The following are typical cases of the first class : — 

Case 1. — A. A civil engineer, of healthy parents 
and of Scotch ancestry ; temperate and in good 
health ; was engaged in British India, building a 
railroad bridge ; when nearly completed, it was 
washed away by a sudden freshet. Great exertions 
were put forth to complete it in a given time. 
Mr. A., being the only engineer, was obliged to 
oversee the work, requiring incessant labor and 
mental strain. 

After a season of prolonged exposure to the sun 
for days, he was taken suddenly unconscious ; re- 
moved to his boarding house, where, in all proba- 
bility, he suffered from a mild attack of meningitis, 
the principal symptoms of which were partial 
unconsciousness, extreme pain and heat in the 
head, of paroxysmal character ; delusions ; face and 
eyes injected ; clonic spasms, and great exhaustion, 
etc., lasting ten days or more, ending in a long 
period of convalescence. 

He suffered from severe neuralgia and ansemia, 
and soon after returned to Scotland. Here the 
physician gave him brandy and beef tea as a 
medicine, for weeks, alternating it with beer and 
raw eggs. 

Unexpectedly he became intoxicated, for the 
first time, and from that date he has been a con- 
stant drinker, using alcohol regularly every 
day, and at intervals of two months becoming 
very much intoxicated for two or three days at a 
time, then returning again to a regular allow- 
ance. Being a man of strong will he sought to 
avoid .these paroxysms of drink by locking him- 
self up or going away from temptation. 

At such times he seemed bereft of reason, was 
irritable, and would resort to the lowest deception 
to procure spirits. This grew until he became 
daily intoxicated, and had frequently tonic and 
clonic spasms. At last he was sent to an inebriate 
asylum, where he grew better, went out, and after 
a relapse was returned. This continued for two 
years ; then his mind began to fail, and he is now 
anaemic, melancholic, and much broken down. 

It would seem that alcohol used during recovery 
from sunstroke was the exciting cause of his drink- 



ing ; at least, it produced organic and functional 
derangements that resulted in inebriety. 

This case was in all probability one of extreme 
exhaustion and progressive anaemia, following the 
meningitis. This was further increased by the use 
of alcohol. There are many reasons for supposing 
that inebriety would not have followed if alcohol 
had been withheld. 

B., a retired merchant, who had, through a 
course of careful, temperate living and saving for 
thirty years, accumulated a large fortune. No 
history of any neurosal affection existed in the 
family. His parents died of consumption after 
sixty, and his brothers and sisters were healthy, 
temperate people. 1 e was married, and all his 
life had been temperate, and for twenty-five 
years past he was a total abstainer, from principle, 
etc. In company with a brother he visited the 
silyer mines of Colorado, with a view of investing 
some money. One day, after a long walk through 
the hot sun, and much exertion, he became sud- 
denly unconscious, was carried into a cabin and 
remained in this condition for over an hour, then 
recovered partially, complaining of severe pain in 
the head, dizziness, etc. He was removed to a 
rude hotel near, where he remained for three 
weeks in his room, suffering from a low form of 
nervous fever. Paroxysmal headache, nausea, 
vomiting, and troubled visions followed ; memory 
was disturbed and his mind was irritable, and 
general loss of functional power was present. He 
was treated with quinine and pmall doses of whisky 
every four hours ; cinchonism following, the quinine 
was discontinued and the whisky was kept up. 

A month later he returned home by easy jour- 
neys, and for six months following complained of 
severe headache and exhaustion at intervals, 
whenever he walked out, or over-exerted himself, 
in any way. During this time the free use of 
brandy and beef tea was recommended, and on 
several occasions he was intoxicated. Six months 
after all attempts to stop the alcohol Avas signaled 
by a return of his prostration, and head symptoms, 
etc. His mind and body both became feeble, and he 
rapidly merged into a chronic inebriate. He is 
now fleshy and comparatively well, although drink- 
ing with every opportunity. 

In this case alcohol seems to have given direc- 
tion to the disorder following sunstroke, and 
developed inebriety. The peculiar condition, 
probably hyperaemia of the brain, that existed 
was especially dangerous for the administration of 
alcohol, favoring the pathological condition of 
alcoholism and degeneration. There is no reason 
to suppose that inebriety would have followed in 
either case had no alcohol been given. 



74 



Communications. 



[Vol. x). 



Casb 3. — C. a. Clergyman in good health, and 
healthy parentage ; while on an excursion, and 
after a long speech, exposed to the sun, was pros- 
trated with sunstroke. He continued unconscious 
for nearly twenty-four hours, then recovered. For 
the next six months he was an invalid, and com- 
plained of depressing exhaustion after any exer- 
tion; neuralgia, headache, loss of memory, and 
derangement of sensation, were present; he gave 
up his charge and traveled for a year, with only 
temporary benefit. Becoming more anaemic he 
was advised by physicians to use brandy and cod- 
liver oil thr e times a day. Some relief followed, 
and the medicine was increased. He became in- 
toxicated, and from this time rapidly merged into 
inebriety, of an impulsive type. He is now under 
treatment for inebriety, with delusions, and is very 
much broken down in health and mind, and 
probably never will permanently recover. 

Case 4.- — A traveling showman with no history, 
except that he was temperate, that is reliable. 
Suffered from sunstroke ; was taken to the hospital, 
and for six months was treated for the sequel of this 
disorder, viz., anajmia, exhaustion and functional 
paralysis. When he came out of the hospital he 
began to use freely whisky and eggs. He re- 
gained his strength, but became within a few 
months a chronic inebriate, of the lowest form, and 
is now serving out a term of imprisonment for 
drunkenness. 

In the second class there appears to have been 
some special condition or exciting cause predis- 
posing to inebriety and favoring sunstroke. In 
such cases it is evident that inebriety was impend- 
ing, and the use of alcohol was doubly dangerous. 
The lesion following sunstroke would very natur- 
ally develop the diathesis or predisposition exist- 
ing before. In this case the sunstroke seemed to 
be the exciting cause. 

Case 1. — B. ; a lawyer with good family history 
and no special diseases inherited ; drank beer in 
college and led an irregular life for some years, 
then reformed. After he was married and had 
built up a good practice, he complained of dizzi- 
ness and exhaustion following any special exertion. 
Loss of appetite for days ; then he would eat to 
surfeit and indicate great capriciousness of taste. 
He was excessively fond of ice and soda water 
drinks ; would eat irregularly, sometimes at night, 
then early in the morning. He suffered from 
severe colic pains in the stomach, at times, then 
was low-spirited for days. 

Anaemia and general functional derangement 
followed ; this continued for years, without any 
special change for the worse. 

After a long ride and exposure to the sun he 



was prostrated with sunstroke and carried home, 
where he suffered from hypertemia of the brain. 
A low fever followed, and it was four months 
before he was convalescent. Soon after this he 
drank to intoxication, giving no reason except 
that he wanted to feel the effects of stimulants. 
From this he drank as often as opportunity oc- 
curred, and seemed to have no conception of his 
danger; only actuated by a morbid craving for 
stimulants, which obscured every other motive. 
He rapidly became a drunkard, and is now under 
treatment, a hopeless case. 

Case 2. — J.; a merchant, inheriting inebriety 
on his father's side ; temperate from his youth up, 
from principle. His temper was changeable, and 
his mind was impulsive and erratic. 

His habits of living were irregular ; he was hy- 
pochondriac, feared death, and was constantly 
using drugs of all kinds, for pains and threatened 
disorders. Functional derangements of both skin 
and the stomach were {)resent. He worked hard 
every day, and spent the night restless and full of 
fears about his health, devising ways and means 
to build it up. He failed in business and was 
more nervous and dispirited. Became a be- 
liever in spiritualism, and while returning from 
a long visit to the Eddy brothers, in Vermont, was 
stricken down with sunstroke. After a few days 
he recovered in part, and was ordered whisky and 
eggs by a physician. From this time all bis dis- 
orders vanished, and he became a constant drinker, 
night and day. Went into the hotel business and 
was wildly extravagant and reckless, and finally 
died, some years later, of delirium tremens. 

Case 3, — H.; an eclectic physician, who had 
served as hospital steward during the war. A weak- 
minded man, who was filled with the delusion that 
some vegetable remedy would be found to cure all 
diseases; hence, he was constantly experimenting 
with all kinds of roots, etc. He was of nervous, 
excitable disposition, and frequently starved him- 
self, from some peculiar physiological notions, etc. 
Was at one time a Grahamite ; then weighed out so 
much food every day, calculated upon the amount 
of exertion he made. Was an?eraic and full of 
delusions, although much respected and patronized. 
While digging roots he was made unconscious by 
the heat, and suffered from excessive exhaustion 
and dizziness for days after. Then he called a 
council of physicians, who urged him to take 
brandy and beef tea. This treatment resulted in 
sudden and profound intoxication, and utter want 
of control ever after, drinking at all times, and 
only governed by circumstances and surroundings. 
He is now an inmate of an insane asylum, for in- 
sane drunkenness. 



Jan. 25, 1879. J 



Hospital Reports, 



7S 



i 



These cases illustrate clearly the predisposition 
that existed before, and the sunstroke followed as 
an accidental coincidence. 

Other cases are met in which no special symp- 
toms precede or follow the attack, giving intima- 
tions of inebriety. The causes are central and 
psychical, and are not recognized in most cases. 

The following cases are typical ones : — ■ 

Case 4. — H , a physician in good health and 
temperate ; much overworked ; was prostrated with 
sunstroke and recovered in a few days ; went away 
to the seashore for two months, and was very much 
restored. No special sequel followed, and for a 
year after he was in excellent health. Then, all 
unexpectedly, he began to drink to intoxication, 
and kept it up day after day. His mind failed, 
and he died a year later, in convulsions, from alco- 
holism. 

Case 5. — J. ; a manufacturer and inventor, in 
successful business, in good health, and very tem- 
perate in all his habits, went down to visit a son in 
the army of the Potomac. He contracted dysen- 
tery, and on the way to Washington suffered from 
sunstroke, and remained in that city for six weeks 
before he was ahle to return home. He suffered 
from general exhaustion, without any pain or 
other symptom. In a year he had fully recovered. 
Two years later he came home intoxicated, and 
could give no statement or history of this occur- 
rence. A few weeks later he drank again to in- 
toxication, with the same loss of memory. From 
this time he continued to grow worse, drinking 
very often and very impulsively, without any 
reason or apparent consciousness of his acts. He 
was sent to an insane asylum and remained there 
two years, recovering, and resuming his business. 
A few months later he drank again, in the same 
unconscious manner, and was returned to the 
asylum. 

From this time up to the present he has 
been alternately drinking and undergoing treat- 
ment in an asylum, sometimes remaining sober 
for a year, then not more than one or two months. 
He is very much shattered in both body and 
mind, and has suffered from partial paralysis. 

Cases of this last type are quite common, and in 
many instances can be traced directly to some 
obscure brain legion, beginning with the sunstroke. 

Often this event has preceded the inebriety for 
months and years ; although often forgotten, the 
connection can only be discovered by an intimate 
incjuiry into the history of the case. 

Whether inebriety is only an accidental form of 
neurosis originating from the presence of some 
exciting causes, or whether it follows as a natural 



sequence of the ansemia and exhaustion from the 
effect of heat, is yet to be determined. 

Some very interesting data have been made 
from the numerous cases of sunstroke during the 
past summer, which seem to indicate that the most 
severe and fatal cases were those who were inebri- 
ates or had been drinkers, also those suffering 
from dyspepda and anaemia with perverted nutri- 
ent disturbances, etc.. One case has come under 
our observation, of a man who, ten years ago, had 
a partial sunstroke, and who has been an uncon- 
trollable inebriate since that time. 

From these cases and hints, I think some infer- 
ences may be clearly drawn, as follows : — 

First. That the use of alcohol in cases that have 
suffered from sunstroke is exceedingly dangerous, 
and liable to be followed by evil consequences. 

Second. The obscure lesions following sunstroke 
very commonly react in inebriety, and should be 
treated in view of this possible termination. 

Third. Inebriety dating from sunstroke directly 
or indirectly is more or less incurable, and of very 
uncertain prognosis. 

Hospital Reports, 
pennsylvania piospital. 

CLINIC OF PROF. DaCOSTA, JANUARY llih, 1879. 

REPORTED BY F. WOODBUKY, M.D. 

Diagnosis and Treatment of Scurvy. Remarks on 
Scurvy in Civil Life. 

Gentlemen : — The first cases I will show you 
this morning are not very frequently encountered 
in private practice, although we see them quite 
often in the hospital. These two men are both 
suffering from scurvy; they have been in the 
wards but a short time. 

Case 1. — T. H. ; is thirty-five years of age ; a^ 
you see, he is a strong, well-built, Englis^h sailor. 
While on a two-months' voyage, from Cardiff, 
Wales, to Carthagena, Spain, and hence to Phila- 
delphia, he lived almost exclusivtly upon salt 
provisions. About two weeks previous to his ad- 
mission to this hospital, which was only day before 
yesterday, he began to suffer from pains in the 
bones and large joints ; and the ankles, particu- 
larly the left, became swollen. In consequence of 
this he was obliged to stop work about eight days 
before entering the war.l. He has had no fever, 
has slept at night; his boweis have been consti- 
pated. He has a moderate amount of debility. 
What he came in for, and wJiat, in truth, seemed 
to be the most marked symptom, was the peculiar 
rheumatic pain. I use the term rheumatic rather 
in the sense in which the patient used it, than in 
my own ; more correct would it be to say that he 
had pains, particularly around the left ankle joint. 
I may say, therefore, that the trouble in thek:nees 
and ankles has been the prominent feature of the 
condition for which he sought relief. We ex- 
amined him yesterday, and accompanying the 



76 



Hospital Reports. 



[Vol. X 



pains we found, what you shall now see for your- 
selves, ecchymotic spots on the inner aspect of the 
left ankle. The skin appears glazed over this spot, 
even suggesting that something has been painted 
over it, which the resident physician assures me 
has not been the case ; it looks exactly as if it 
had been brushed with collodion. The patient 
complains oi" want of power in the knee and some 
pain on motion of the joint. There are no well- 
marked spots except these you see ; a few higher 
up are less evident. I have already told you that 
he had also general pains, although it is only the 
left side which presents this peculiar appearance 
which you observe here. Now we turn to the other 
symptoms. What is most peculiar, and really gave 
us the clue to this case, is the condition of the 
gums. They are swollen, red and soft; this I 
find is more marked in the upper than in the 
lower jaw. Look at this gum ! It is characteristic ; 
it is the spongy gum of scurvy. The tongue is 
clean. The breath, at first, was fetid ; it is less so 
to-day. The bowels have been constipated. 

The urine has. been examined and found to be 
acid, and free from albumen. The axillary tem- 
perature is normal, only 982^° Fahr. 

Listening to the chest, more particularly to the 
heart, 1 find a soft systolic murmur, most marked 
over the body of the left ventricle. The area of 
splenic dullness is large, and extends to the margin 
of the ribs. Hepatic dullness is normal. There 
are no signs of dropsy. He has no cough, and has 
had no hemorrhage from the lungs or nose. This 
completes the clinical record of the case. 

Now I will bring before you patient number 
two. This is a less well-marked case ; and, indeed, 
were it not that we were aware that he came from 
the same ship, and had, therefore, been exposed to 
the same diet and similar circumstances, his scor- 
butic condition might have been overlooked. It 
is a case up^n which we should dwell less, and this 
feature might, in truth, have entirely escaped 
observation. He complains also of what he calls 
rheumatism, or, if you will excuse the term, pseudo- 
rheumatic pains, false rheumatism. He labors 
under more debility than his shipmate. 

Case 2 is William B., 32 years old. He has the 
same shooting pains in the legs that number one 
presents, and looking into his mouth we find that 
he has the same spongy, scorbutic gum, the same 
clean tongue. No fever; no albuminuria; no 
marked dyspeptic symptoms, but the bowels have 
been constipated. There has been no special de- 
pression of mind that he has noticed. 

Now, gentlemen, this case is not quite so pure a 
case as the first, only for the reason that a history 
of syphilitic infection exists here, and we might 
well have attributed the pains in the case to the 
specific complication, were it not for the appear- 
ance of the gums and the fact that he came from the 
same ship as the preceding and more typical case 
did. 

I will only add, and this belongs to the clinical 
history, that we have the same systolic murmur 
in this patient that we noticed in nvmiber one, 
except that there co-exists greater rapidity of the 
heart's action and more signs of debility. 

Having examined these two cases, let us now 
group them together, and see in what points they are 
alike, and where they differ, and finally make a 
few explanatory remarks. 



Let me, first, call your attention to the causative 
element in these two cases of scorbutic disease. 
Sailors exposed for a long time to the same diet, 
with the hardships incident to their occupation, 
with insufficient food — insufficient in so far as it 
is composed of salt provisions, which fail to me -t 
the requirements of the system— are peculiarly 
liable to suffer in this way. Scurvy, as we now 
know, is caused most commonly by the Avithdrawal 
of the vegetable juices from the daily food, but it is 
also produced by oneness or sameness of diet, and 
may be induced by one purely animal. Even fre-;h 
meat, if exclusively or inordinately eaten, will 
cause it after a while ; becau^se those elenitnts in 
the blood that are to be furnished by the vege- 
table structures are necessarily deficient. It is a 
mistake to suppose that only salt food can produce 
scurvy, for it may also occur while eating fresh 
meat, but we must admit that the salt food causes 
it more rapidly and completely. 

This much for the causation ; let us now see if 
anything of interest is discovered in glancing 
over the symptoms these cases mutually present. 
Have we here marked cases of scurvy ? and 
what are the significant symptoms of this malady ? 

First, Are these marked cases of scurvy ? I 
have called your attention to the rheumatic or 
pseudo-rheumatic pains in the lower extremities. 
These are the common accompaniments of scurvy, 
as a general rule. Patients will come to consult 
you for rheumatism ; and it is only by the li^ht 
thrown upon the case by the character and locality 
of the pain, and the co existing? symptoms, tiiat 
you see that it is not one of rheumatism. Pains 
and aching in the bones, stitlhess in the joints, 
with suffering increased by motion — these are the 
essential features of the pseudo-rheumatic pains 
that accompany scurvy. My experience is that 
these painful seizures are almost always confined 
to the lower extremities ; or, at least, it will be 
there where they will be most marked. Both 
cases have this symptom, and both cases have 
spongy gums — of all signs the most significant 
one of scurvy. While we may have suspected 
scorbutic, I do not think that we could have de- 
termined this diagnosis positively in these case* 
without the aid of this striking appearance of 
the gums, characteristic of scurvy. Both patients 
have a clean tongue, fetid breath and constipated 
bowels — also common symptoms of the malady. 
In this they are also both alike. But in No. 1 
we have additional points, not observed in Xo. 
2. We have ecchymosis around the ankle, with a 
glazed appearance of the skin, which [ have found 
to be very common, if not characteristic of scor- 
butic extravasations. This patient also has some 
enlargement of the spleen, and as he has never 
had malarial fever, the marked enlargement of X,h% 
spleen has tJie greater significance. 

We also have here a feature which is not ordi- 
narily known in connection with scurvy, that is, 
the existence of a systolic murmur ^n the heart. In 
No. 1 it is more marked than in No. 2 ; but it is 
heard over the left ventricle in both cases. There 
are no signs of valvular disease, nor of cardiac 
enlargement ; these sounds are simply blood i 
murmurs. 

I have now given you the general symptoms, 
and when I have said that neither have had any 
fever, and in neither has any evidence of renal 



Jan. 25, 1879.] 



Hospital Reports. 



77 



disorder occurred, I have exhausted the clinical 
points presented by these cases. 

You will ask me, do such cases occur in private 
practice? To this I must answer both yes and no. 
Marked instances of scurvy you are not apt to find 
in private p actice, but less marked or semi-scor- 
butic cond tions from imperfect nourishment, we 
do have, and not infrequently. Cases I could 
cite from my experience, occurring in families 
of the higher walks of life ; dyspeptic patients, 
who, h iving digestive trouble, first drop one arti- 
cle of food and then another, until, finally, they 
come to mainly a meat diet, or milk, and live 
almost exclusively upon one article, and this in 
insufficient quandty. They tell you that they 
have a poor appetite, cannot eat, everything dis- 
agrees with them, iinl you find that they are scor- 
butic. Tliey may roll in carriages, and be sur- 
rounded by wealth and luxury, but they are starv- 
ing on insufficient food. You will not expect to 
find in sach patients these well-marked symptoms 
of scurvy, but you will notice the evident exhaus- 
tion, the spongy gums, the clean tongue, the fetid 
breath, the ten lency to constipation, and peculiar 
pains. To this la t-r symptom I must again call 
your attention, particularly in private practice. 
These pains, similar to rheumatism — -pseudo-rheu- 
matic, if you choose — constitute the principal com- 
plaint for which the patient seeks the physician ; 
for which he us.^s liniments, electricity, and goes 
to the watering pi ices and baths, but all in vain. 
His paihs get no better. He almost always sup- 
poses that he is rheumatic. Now, gentlemen, you 
will understand the cause ; it is scurvy, though 
poorly developed ; you will be enabled to cure \ 
such cases by r'-cognizing the cause, and treating 
them intelligently. Many, many cases I have 
helped in this manner, by putting them upon a 
varied diet, and carefully attending to their 
hygienic conditions, and general treatment sug- 
gested by the condition of the blood. In this, 
which I may call the scurvy of civil life, I have 
also found these ecchyraotic spots, in patients 
living in luxury and having everything around 
them to gratify their tastes. 

We n>)W come to the question of treatment : what 
shall we do for such patients. First, those like 
No. 1, p'.ire ca<^es of scurvy, must have a varied 
diet, cornpjsed largely of fresh fruits, vegetables, 
spinach, et3. Onions are an excellent anti-scor- 
butic, although, perhaps not very pleasant for 
those who are in patient's immediate neighborhood ; 
potatoes are a so valuable; oranges, lemons, applet, 
and as varied a diet as the season affi^rds may be 
given ; in other words, we should introduce the 
elements of fresh vegetables in the most convenient 
form, (irenerally you can do this, but where you 
cannot adopt it at once, you will find that lem- 
ona le. freely usid, will prove a valuable substitute. 
In a 1-iition, the patient may have fish, always 
provide i that it is not salted. 

When we turn to the question of treatment, irre- 
spective of diet, up n which, however, I wottld 
lay ths most str3ss, we find that mineral acids do 
tiie most good. Of course, where there is an 
anjemic murmur you would also think of iron. 
In fa.'t, he is now taking an acidulated tincture 
of iron — 

K. Tinct. ferri chlorid., gtt. xx 

Acid, muriatic, gtt. x. M. 



given largely diluted with water, three times a day. 
Upon this treatment we will keep him, with con- 
siderably hopes for success. 

In Case 1, we must modify the treatment, on ac- 
count of his specific history ; you may have noticed 
the remains of an old syphilitic eruption upon 
his face. We shall give him the same diet and 
the same prescription, but, in addition, a twentieth 
of a grain of bichloride of mercury with each 
dose. 

We shall not now stop to speculate whether 
these attacks might have been prevented, by the use 
of lime juice, which all captains should carry with 
them when going on a long voyage. Whether 
they could be prevented or not, is an interesting 
que.^tion, but we have already spent too much 
time upon other points to stop now to discuss it ; 
nor, indeed, does it properly belong to the clinical 
appearances of scurvy which I have this morning 
endeavored to show you. 

Apoplexy with Hamiplegia, and Syphilitic Brain 

Disease. Eapid Recovery Under Iodide of 

Potassium. 

The next case to which I wish to call your at- 
tention is one of brain disease. 

This patient has been in the hospital since 
December 30th, 1878. His name is Henry T., 36 
years of age ; he is a butcher. Fifteen years ago 
he contracted primary syphilis, followed by well 
marked secondary symptoms, skin eruption, sore 
throat, falling out of hair, etc. Three or four 
months before admission to the hospital he was 
attacked with a severe pain in the left side of his 
head, which was so violent as to confine him to 
bed, and require the use of chloroform. I call 
your attention to this history, particularly the 
early history, for it will bear very closely upon 
the clinical consideration of the case. This severe 
pain was relieved in a few days, and he was able 
to return to work in a provision store. 

I will now put several questions to him, which 
could hardly be done before, on account of his 
dull condition, but which relate to some points 
that it is important for us to learn He tells us 
that following this severe pain he had headaches 
occasionally, and sometimes giddiness ; but never 
falling until the day of admission. He has not 
been losing fiesh. His eyesight has not been 
disturbed. I have now filled up the space in our 
record from the time that he was first taken 
to the day he came into -the hospital. We find 
that in this intervening period he was not entirely 
free from pain and vertigo, but there was no in- 
volvement of any of the special senses. He says, 
positively, that he did not escape headache for 
more than two days at a time, since his first attack, 
to the time of entering the hospital. 

On the morning of admission, while apparently 
in health, he was seized with marked dizziness 
and loss oi power in the left arm and leg, falling 
suddenly to the floor. I have not said that he 
bet!ome completely unconscious, but his mind was 
so confused by the vertigo that he cannot tell much 
about the attack, except that he suddenly fell. At 
all events, his consciousness was materially im- 
paired : he had marked difficulty in speech ; and 
a severe pain in the right frontal region. This 
attack had not been preceded by a headache, and 



k 



78 



Hospital Reports. 



[Vol. xl, 



he was not engaged in violent exertion or strain- 
ing at the time ; he nays that he was simply tying 
his necktie. Let us add to this record that he 
never suffered from inilamma^ory rheumatism, 
and has had no disease of the heart or kidneys ; 
he has had, however, undoubted evidences of con- 
stitutional syphilis. 

The man wa> brought into the hospital with 
loss of power on the entire left side of the body. 
With the paralysis of tlie arm and leg, there was 
effacement of the wrinkles in the corresponding 
side of the face, with inability to tightly close the 
eye, and loss of power of external rectus, as shown 
by inability to rotate tlie eyeball to the outer 
canthus The pupils were moderately dilated, 
but were not irre>,'uiar; they responded sluggishly 
to the light. His ment;d condition was dull ; 
he answered questions reluctantly and slowly, 
but intelligibly ; liis speech was thick, on ac- 
count of some trouble in managing the tongne, 
but there was no aphasia, strictly speaking; 
the words he used were correctly used. He was 
drowsy and dozing, and yet complained that he 
was prevented from sleeping by the severe s ipra- 
orbitai pain in the right side. It was difficijlt to 
decide in regard to sensation, on account of his con- 
dition, but as far as cnuld be observed sensibility 
was not lost, and certainly reflex excitability was 
well marked. I have only to add that he had a 
strongly-acting heart, and it was fomid that there 
was a small amount of albuminuria, which was 
only temporary, and belonged to theatiack ; it had 
not been there previo tsly. There h:is been a 
smad amount of aibumen in the urine since his 
admission to the hospital, but it has to-day dis- 
appeared. It was the c ns quence and not the 
cause of the aitack. Therefore the statement 
made a few moments ago, that there was no previ- 
ous disease of the kidneys, was a correct one, but it 
needed this explanation. 

You see he Juts markedly improved. Tv^elve 
days after the seizure, the left arm, which he could 
not move when he came in, he now lifts up readily. 
He has a pretty firm grasp, bttt still it is not as 
strong in the left as in the right liand. He can 
walk and kick witlj the left leg, but it is feebler 
than the right. Sensation is good on both sides 
To complete ihis record I will staie that yesterday 
we examined the eyes, and find that there is no 
evidence of optic neuritis, but that there were, in 
both eyes, minute retinal hemorrhages, chiefly dis- 
tributed along the course of the arterits; these 
were not of recent appearance. 

1 have niAV spoken of everything in the case 
except the treatment. He was purged with croton 
oil. Bli-^ters were applied to the neck, and he 
was ordered large and frequent doses of iodide of 
potassium, ten grains every three hours, being 
almost ci instantly given. Un er this treatment, 
as yon sh^, the man has so completely recovered 
that if yoti had not heird this history of well- 
ni; r'.ed hemiplegia, you could not believe that 
he had rejentiy been so ill. The facial palsy has 
n(jt entirely disappeared ; when he tries to whistle 
the .ei't cheek puils out. This shows that some 
leaiu)) still exists, similar to that aflecting the arm 
and the leg, Avhere we saAV that while there is a 
greit return, there is still some loss of power. 

jMovv let us inquire what has been the trouble 
here ! Was the treatment a proper one ? And 



should the treatment be now modified ? You have 
heard the history; you see the patient now walk- 
ing out of the room ; noticinor his gait you want to 
know what is the matter with the man, under what 
he has suffered, and what may be his future. 

This man has had a blood clot in the brain, which 
caused the attack for which he was admitted. 
This clot exists in the corpus striatum, or in a 
great centre of the motor tract on the right side of 
the brain. The clot was a small one, or only of 
moderate size. Why do I say this ? Because only 
a clot or an embolus could explain this sudden 
attack of palsy — a man in health suddenly falls to 
the ground and finds himself paralyzed. JN^othing 
but an extravasation of blood or the closing of 
vessels by a plug could produce this. * But in the 
absence of disease of the heart, the common causing 
element of embolism, considering the suddenness 
of the attack, which is aoain.iu favor of clot 
rather than embolism (though both are rapid), and 
from his speedy recovery, I must pronounce in 
favor of a clot, which is more apt to rapid ly dis- 
appear than a plug. Owing to the fact that the 
loss of consciousness was not quite complete, and 
witnessing the rapid improvement, I. further con- 
clude that the clot was a small one. In a large 
extravasation consciousness would be completely 
lost, and being slowly absorbed, its etlects would 
be proportionately lasting. Now^ what are my 
reasons for locating it in a great motor gat^glion or 
centre upon the right side of the brain ? They are 
very evident, from your study of the efiects of brain 
lesions. Loss of power in the left arm, leg and 
face, without marked impairnient of sensioility, 
point to the motor tract, most probably the corpus 
striatum of the opposite side. I need not dwell 
longer upon this point; the cerebral symptoms 
show that the injury is not of spmai origin. 

I have said the immediate lesion was a clot. 
Is all this a mere attack of apoplexy, or is there 
something else lying back of it? Only a clot or 
something more ? I think that there is something 
behind it. Now, with the evidence of eye dis- 
order, which could only be surmised on admission, 
I say that he has organic syphilitic disease of the 
brain. He has brittle arteries, irom syphilitic de- 
generation. Arteries whose coats iiave become so 
diseased as to readily break ; which is one of the 
I consequences of syphilis wdien long standing. The 
attacks of vertigo are indications strongly in that 
direction, furnishing eN'idence of previous disease 
' of the cerebral vessels ; syphilitic arteries, you 
I may term them. But will this explain the entire 
^ trouble ? Hardly. This is due to one of two 
causes. There is either syphilitic disease of the 
base of the brain, in the form of a small gummous 
tumor, or else syphilitic meningitis accompany- 
ing the disease of the arteries I have already ex- 
plained to you. If you ask me which it is more 
likely to be, I would answer the latter, for the 
character of the symptoms is more in favor of a 
meningitis than an exudation. 

The hour having expired, I will be unable to ex- 
plain the rationa e of the treatment by the iodide 
of potassium, blisters and purging, which has been 
so signally successful. In closing, I will merely 
state that the iodide shall be continued, in order to 
favor the removal of this extravasation existing at 
the base of the brain, while we carefully watch over 
his general condition. 



Jan. 25, 1 879. 1 



Periscope. 



79 



Editorial Department 



Periscope, 



Experiments in Transfusion. 

At a late meeting of the Societe de Biologie. 
Dr. Brown-Sequard gave an interesting account of 
his experiments on tran.sfusion. He had made 
use of different sorts of liquid for tram^fusion, such 
as normal Llood, blood without its fibrine, and 
milk. In each case he found the results to be the 
same, but in the case of the milk the quantity that 
it was necessary to inject was more considerable 
than in the others. Ninety-five grammes of blood 
were drawn from a dog, and were replaced by the 
same amount of milk. Shortly after the operation 
(about forty-five minutes), there was no trace of 
milk globules to be found in the bU)od, and the 
dog has continued in excellent health ever since 
the operation, which- took place more than five 
months ago. M. Maiassez found, upon examining 
the bioud after transfusion, a greater number of 
white globules than normal. In concluding his 
remarks. Dr. Brown-Sequard expressed the opinion 
that the licjuid injectea should be at least of a tem- 
perature of 10"^ to 12*^ C. It was preferable, he 
thought, to choose the arteries ratherthan the veins, 
and recommended the operation to be done very 
slowly, in order to allow the liquid injection to 
acquire the temperature of the blood. Transfusion 
also succeeds in animals when the blood made tise 
of comcS from a species of animal difierent from 
that of the one under experiment. 



The Nature and Treatment of Acne. 

At a recent meeting of a branch of the British 
Medical Association, l3r. J. Herbert Stowers read 
a paper on the nature and treatment of acne. He 
considered acne one of a distinct group, including 
diseases of the glandular system. It prevailed 
from puberty to thirty years of age. Acne rosacea 
was distinct from all the other varieties, which were 
merely stages. In the first stage, there were 
nodules, with comedones ; then came acne coni- 
lormis, vrich inflammation ; then acne pustulosa, 
with more inflammation ; and, fourthly, acne 
tuberculata, with infiltration around. Debility 
was ttie great disposing cause. In the syphilitic 
form, the pimples were indurated and left dis- 
colored marks. He referred to iodine and bro- 
mine acne. The iodine form showed less ten- 
dency to beco;ne pustular ; the bromine form was 
larger. Pie considered separately acne rosacea. 
It was six times more common in females, and 
was due to constitutional causes. Inflammatory 
congestion was the primary disorder, generally 
produced by too much alcohol auLl too little food. 
The treatment of acne was to avoid pastry, cheese 
and stimulants, and give salines wuth or without 
iron, remove comedones with warm soap and 
water after steaming. Turkish baths were useful. 
He recommended dilute citrine ointment with 
one-third sulphur vaseline, etc. ; a lotion of bichlo- 



ride of mercury with bismuth and oxide of zinc, 
or of sulphur, camphor, glycerine and lime water. 
Apply the lotion twenty or thirty times daily, and 
use ointment at night. In acne pustulosa, the 
internal use of sulphide of calcium in doses of 
one-sixth of a grain was useful. Indurated 
points were to be touched with acid nitrate of 
mercury, or strong perch loricle of iron. He 
recommended perseverance in treatment. Acne 
rosacea was very amenable. All excitants, alco- 
hol, etc., were to be removed, and soups avoided, 
substituting gruel. Iron, with arsenic or mercury, 
should be used, and lotion, with sulphur pre- 
cipitated, very frequen ly applied. \Yhen there 
was chronic dyspepsia, oxide of silver in grain 
doses three times a day was useful. When con- 
gestion was less, zinc ointment, with ten grains 
of carbolic acid to the di-achm, might be applied. 



Tlie Skin in Tinea Tonsurans. 

Dr. Frederick Taylor lately read a paper before 
the London Medical Society, on tbe condition of 
the skin in tinea tonsurans. The subject or the 
disease died of tubercle of the cerebellum, after a 
long illness, and the ringworm was oniy partially 
treated. A portion of the scalp was hardened in 
alcohol and chromic acid, and sections were 
stained in logwood and picrocarfiiina. Tf.e results 
of the examination were as Ibllows ; Numerous 
hairs were aflected by the fungus, some in an 
early stage, others in an advanced stage. In the 
former the hair retained its form, and had within 
it simply a varying number of mycelium tiireads 
running parallel to its length, in the later stage 
the hair was obscured by a crowd of spores closely 
packed in the follicle; in the middle of these llie 
outline of the hair was seen, but its substance 
seemed to be completely deslroyed or replaced by 
mycelium threads running in a longitudinal direc- 
tion. In a downward direction the fungus did 
not reach beyond the upper end of the buio of the 
hair. The hair papillae were never invaded. 
Laterally, the spread of the fungus was limited by 
the inner root sheath, with which, in advanced 
stages, the spores were in contact. The integrity 
of this sheath was maintained, even where the 
follicle was choked with spores. The outer root 
sheath never showed any trace of fungus ; nor did 
the follicle walls, subcutaneous tissue, cutis, and 
mucous layer of the epidermis. So much of the 
horny layer of the epidermis as remained in 
these specimens showed no fungus, even in the 
immediate neighborhood of diseased hairs. The 
diseased hairs were not twisted or broken, as in 
Dr. Thin's specimens (paper read before the 
Society, March 26th, 1878 j, nor were any but the 
merest traces of inflammatory action present. 
From these results it appeared that the fungus 
invades the hair proper and advances in its sub- 
stance down toward the bulb; that it never ad- 
vances far into the bulb or attacks such tissuts as 
the root sheaths ; that its growth in the follicle is 



8o 



Reviews and Book Notices. 



|Vol. xl, 



determined by the supply of hair from the papilla, 
the freshly formed soft cells resisting its action 
until in their turn they assume the characteristics 
of the proper hair substance ; that should the 
papilla fail to form new hair cells, the fungus 
must shortly starve. 

The Diet of the Gouty. 

In a late lecture on " gouty heart/' Dr. J. M. 
Fothergill gives these directions about diet : The 
patient should be put upon a dietary which should 
consist of farinaceous material, fruit, fat, and lish. 
Fish, of course, contains nitrogen, like all other flesh, 
but a gouty person may eat a good meal offish, and 
enjoy it, without getting any great excess of 
azv)tized material. Then he should take a good 
amount of vegetables of all kinds ; in winter, 
potatoes, turnips, carrots, winter greens ; in spring, 
spinach, but not much asparagus, for that vege- 
table contains a quantity of oxalates which tease a 
gouty system annoyingly. Consequently, rhubarb 
is to be avoided ; and salads, which should form a 
portion of the daily dietary of the gouty all the 
year round, as far as possible, should never con- 
tain sorrel, the Rumex acetosus, on account of the 
oxalates present in it. Cxreens of all kinds, except 
those just mentioned, cooked and uncooked, should 
form a considerable p )rtion of the dietary. A 
lobster salad is the typical food of the gouty man 
whose digestion is perfect. In those gouty people 
who are also dyspeptic, such food is inadmissible 
and the dietary is a limited one. But dyspepsia 
usually protects the system of the gouty, and, in 
fact, takes care of it. The gouty dyspeptic usually 
attains a good old age. In those whose hearts are 
dilated as well as hypertrophied, it is well to see 
that the food does not produce flatulence, which is 
not only uncomfortable, but is not without danger, 
as the elastic gases press upon the heart through 
the thin diaphragm, and impede its action, as well 
as to a certain extent opposing the filling of the 
chambers during diastole. 



The Ethylates of Sodium and Potassium. 

These are caustic alcohols. Dr. Benjamin W. 
Richardson, of London, gives the following ex- 
p.'rimen:al case with them {Lancet, Nov. 1878). 

In 1870 I treated with the ethylate a case of 
nsevus on the neck of a child two years old. Not 
more than six applications of the fluid were made 
wiien the n^evus was entirely removed, and a 
soi:nd surface was left. The noevus in this instance 
was so small I did not consider the trial of suffi- 
cient value ; but soon afterward my friend, Mr. 
Gay, was good enougli to show me a case of nsevus 
of I he scalp in a child under his care at the Great 
Northern Hospital. The nsevus was of the full 
size of a h.ilf-erown, and extremely prominent. 
It had. been treated on various plans — by tying, by 
nitric acid, and other methods, but without success. 
Mr. Gay having consented to my request that the 
erliylate should be applied in this case, I sent a 
spt-cimen of the remedy to the hospital, for use 
there. Instead of this the patient was sent to my 
house, that I might apply the caustic myself I 
commenced by covering the nrevus lightly with 
the soliUion. The application gave very little 
pain, but soon a dark surface showed that the 



caustic had taken effect. Three days afterward a 
firm, hard incrustation had formed where the 
caustic had been applied, which incrustation I 
did not then remove. A few days later, the hard 
crust being loose, I gently raised it away, to find 
the nsevus greatly reduced in size. The ethylate 
was again applied to the surface of the naevus, and 
the same process was contin led until the naevus 
was entirely removed, and a natural surface was 
left. The case was under my treatment nine 
weeks and three days. Some time afterward the 
child was brought to me so completely well that it 
was not easy to discover where the naevus had been. 



Reviews and Book Notices. 

book notices. 

The Science and Practice of Surgery. Including 
special chapters by different authors. By 
Frederick James Gant, f.r.c.s., etc. Second 
edition, revised or rewritten, with 969 illustra- 
tions. In two volumes. Philadelphia, Lindsay 
& Blakiston. pp. 848, 939. Price, cloth, $12, 
leather, $14. 

The author of this work is Senior Surgeon to 
the Koyal Free Hospital, London, and as a 
metropolitan surgeon, has enjoyed a wide ex- 
perience in the chirurgical art. As an author, his 
name has been familiar to the English reading 
medical public for many years. 

The treatise he presents is intended to cover the 
whole domain of surgery. As stated in the title, 
the author has been assisted by various others, 
all of them of acknowledged position. Thus he 
mentions that the chapters on diseases of the eye, 
that on the ear, that on the throat, that on the 
skin, and that on diseases of the female genital 
organs, have been revised by distinguished spe- 
cialists in those depart- lents. We may, there- 
fore, justly conclude that it has been well done; 
and on turning to a number of subjects, we have 
found them carefully and ably handed. The 
points which have impressed us most are the full 
references to the works of others, the ample dis- 
cussions of debated points, the extensive arrays of 
cases and their results, and the number and variety 
of the illustrations in the text. In all these 
respects the work is not stirpassed by any other 
that we can name. 

Nevertheless, it is a fact that it is no longer pos- 
sible to present anything like a full treatment of 
surgery in two volumes, even of nearly a thousand 
pages each ; and we think Mr. Gant and all other 
surgical writers might as well give up the attempt. 
For instance, the whole of the subject of " Injuries 



Jan. 25, 1879 ] Reviews and Book Notices. 



S 



and Diseases of the Female Genital Organs " is 
squeezed into less than twenty medium octavo 
pages — less than the compass of the reading 
matter of a single number of this journal. And 
the same might be adduced of half a dozen other 
not less important topics. It is vain to suppose 
that any but the most superficial sketch of subjects 
can be given with such brevity. 

Various slight errors and omissions have struck 
the eye in looking over the work. For instance, 
Dr. L. Bauer is not "of Philadelphia" (p, 418, 
vol ii) ; it is very absurd to speak of the intro- 
duction of the speculum as " demoralizing " (vol. 
i, p. 357) ; it is hardly correct to say that the 
pathological histology of syphilis exhibits " noth- 
ing remarkable " (vol. i, p. 270) ; the use of curare 
in hydrophobia should have been mentioned, etc. 
But these slight criticisms will not detract from 
the general merit of the work ; it is a carefully 
studied production, and will, no doubt, meet with 
an appreciative reception. 



NOTES ON CURKENT LITEEATUEE. 

In a neat pamphlet three cases of optic 

neuritis are described by Dr. C. J. Lundy, of 
Detroit. 

The Philadelphia Chemist and Druggist has 

changed its title to "The Monthly Eeview of 
Medicine and Pharmacy," and will hereafter be 
published by Keasbey & Mattison. 

Dr. Henry Gibbons, Jr., of San Francisco, 

gives, under the title " Fifty Years Ago," an inter- 
esting sketch of medicine in America about 1828. 
It is an exceedingly well-merited tribute to the 
gurgeons and physicians of a past generation. 

The value of absent "tendon reflex," a 

diagnostic point we explained and discussed in 
the Eeporter, current volume, p. 18, is further 
studied by Dr. Allan M. Hamilton, in a reprint 
from the Boston Medical and Surgical Journal. 
His results are not so definite as those we men- 
tioned, on the page referred to. 

Dr. W. J. Hoffbaan, of the United States 

Geological and Geographical Survey, sends us a 
reprint of his article on the mineralogy of Nevada. 
Nevada is rich, not only in precious metals and 
rare minerals, but in sulphur, thermal and saline 
springs, a number of which are described by Dr, 
Hofiman. 

Dr. Geo. M. Beard brings out, in a reprint 

from the Journal of Inebriety, another one of his 
Taluable studies of mental mojbid states. Th,e 



title is "Are Inebriates Automatons?" He oti- 
cludes that sea air has a peculiarly strong influ- 
ence to excite to "tippling strong liquor galore," 
as the old song says. It suggests that the general 
demand for such things among watering place 
visitors may be of a sort of automatic character. 
He also has an interesting note on the " Jumpinjjf 
Frenchmen " in Maine, and the " Holy Rollers " 
in Vermont, the latter a class of revivalists who 
roll over and over on the ground when they "get 
religion." 

Dr. E^ A.- Groux, the individual who for 

twenty years and more went from college to college, 
showing his chest without a sternum, and an ap- 
parent power of voluntarily suspending the heart's 
action, died in Brooklyn last year, and the Proceed- 
ings of the Kings Co. Medical Society has an article 
on his anatomy, by Dr. Charles Jewett. 

^Of all the daring and original suggestions 

in sanitary science, the most so is that contained in 
a paper read before the Maine Medical Associa- 
tion, by Dr. George F. French, of Portland, on 
the best means of eradicating syphilis. The author 
has discovered a means which be thinks will 
extirpate the disease to a surety. It is this : Let 
every man who has syphilis forthwith be castrated ; 
let every woman who has syphilis be spayed ! ! The 
suggestion takes our breath away to that extent 
that comment is impossible. 

Another letter in re Hammond vs. Grissom ; 

this time from the plaintiff, who promises G. both 
a civil and criminal suit if he catches him in New 
York State, and proposes a Court Medical tc^ ^1^ .. 
cuss the question. We imagine Dr^ Q./w;iili nofc 
drink Saratoga water at the spring ^Q^J^ sjimm^i-:^ 

Godei/s Lady's Book^ ^his year, starts out 

under new and energetic auspices, with a first- 
class corps of writers a^d artists to throw their 
double charms of narrOstixe anjdj a,dornment over 
its pages. No other jojjt^nal has so much,to>^Miies.tj' 
the ladies of the hoiisehold, and no^e Qan he more., 
heartily commefltd^ tq. the fab portion of the;., 
family. Pric^ per year is $'^4^0:, with the E.e=.._ 
PORTER, the tMco> for |6.50, 

— — ^The Jpublie Zt.edger^ Aimctncbc- appears fon. 
1879;, with its usuaj. rich store of iAformationo 

-—Dr. Edward Se^i^nj's J^eccrd c£ Meddfiat^ 
Observaiimh is now in its tweaty-second, edition.. It, 
consists in a series oi, Wanlv farads for -^riting pr^r- 
scripilians, apposite to, which are spaces foj: ^nter-^ 
ii^ the puke, tOiUgiie, temperature, respirj^tion, etc. 
They are very useful blanks, ajjd deserve wide 
adoption. Pri^, four blanks, for ^l.QO*> Sent bj. 
mail from thj.§. office. 



82 



Editorial. 



[Vol. xl. 



THE 



A WEEKLY JOURNAL, 

Issued every Saturday. 



D. G. BEINTON, m.d., Editor. 



The terms of subscription to the serial publi- 
cations 0/ this office are as follows^ payable in 
advar.ce: — 

Med. and Surg. Reporter (weekly), a year, $6.00 
Half- Yearly Compendium of Med. Science, 2.60 
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Physician's Daily Pocket Record, - - 1.60 
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For advertising terms address the office. 

Marriages^ Deaths, and Personals are inserted 
free of charge. 

All letters should be addressed, and all checks 
and postal orders drawn to order of 

D. G. BrINTON, M.D., 

115 South Seventh Street, 

Philadelphia, Pa. 

THE CONTAGION OF TUBERCULOSIS. 

All travelers are familiar with the fixed belief 
of the natives of Southern Europe, that phthisis is 
contagious. When a patient dies in a hotel they 
disinfect the room and destroy the furniture, or at 
least pretend to do so, and charge it in the bill. 
So, too, the history of health resorts appears to show- 
that the frequent arrival of phthisical patients in a 
locality previously almost free from the disease 
surely disseminates it among the inhabitants. 

Some recent contributions to the study of this 
subject seem to place the fact of contagion beyond 
doubt. These contributions are both practical and 
experimental. One of the most remarkable is by 
Dr. Hubert Reich, a resident physician in the 
little town of Neuenburg, a place of 1300 inhabit- 
ants on the Ehine. His account appears in the 
Berliner Klinische Wochenschrift, No. 37, 1878. 

It appears there were two midwives in Neuen- 
burg, one of whom died a year or two since, of 
chronic phthisis. She continued her occupation 
up to a few weeks before her death. Ten of the , 



cliildren whom she delivered while in her marked 
tuberculosis died of tuberculous meningitis. No 
such fatality attended the deliveries of the other 
midwife, nor was the disease at all common out- 
side of the families she attended. It was well 
.known that she was very fond of her babies, con- 
stantly fondling and kissing them, thus breathing, 
for hours daily, into their faces her breath, laden 
with the septic products from the cavities of her 
lungs. The case, indeed, as presented by Dr. 
Eeich, is the most direct and unequivocal we have 
ever read. 

His conclusions have striking support from a flj 
number of experiments on animals, by Dr. Tappe- 
NiER, of Meran, published in the October number 
of Virchow's Archiv der Pathologie. 

The animals experimented on were made to 
breathe for several hours daily in a chamber in the 
air of which fine particles of phthisical sputum 
were suspended. The sputum having been mixed 
with water, the mixture was atomized t»y a steam 
atomizer. In all cases the sputa were from persons 
with cavities in their lungs. Dogs alone were 
employed in the experiments, since they very 
rarely suffer from spontaneous tuberculosis. The 
result was that of eleven animals expuriraented on, 
with one doubtful exception, after a period varying 
from twenty-five to forty-five days, all, being 
killed, presented well-developed miliary tubercles 
in both lungs ; and in most of the cases tubercles 
were present to a smaller extent in the kidneys, 
and in some cases also in the liver and spleen. 
Microscopical examination was in accord with the 
naked-eye appearances. 

The quantity of sputum necessary for the effect 
is certainly a very small one. In three experi- 
ments only one gramme of sputum was daily 
atomized in the air of the chamber, and the quan- 
tity of dry sputum must have been exceedingly 
small. Two ways are conceivable in which the 
infection is produced. The particles certainly 
may reach the alveoli, for powdered cinnabar ad- 
ministered in the same way was found to have 
stained the alveoli in twelve hours after an inha- 
lation of only one hour's duration. But some 
particles may lodge in the mucous membrane of 
the throat and pharynx, and thence, being ab 



Jan 25, 1879.] 



Notes and Comments. 



83 



sorbed, may affect the lungs as organs specially 
predisposed. Hence some comparative experi- 
ments were made by feeding dogs with the same 
sputum as that employed in the inhalation experi- 
ments. Fifteen grammes were mixed daily with 
the food of each dog. In two dogs fed at Munich 
miliary tubercles were found in the lungs after six 
weeks' feeding ; in six others fed at Meran all the 
organs were normal — a difference the explanation 
of which is not very clear. In the cases in which 
the disease was produced by feeding, the intestinal 
tract was affected, whereas it was free in those 
cases in which the inhalation was employed. It 
is remarkable that, with two exceptions, the 
animals, up to the time at which they were killed 
and found diseased, were well and lively, and 
indicated their disease neither by emaciation nor 
other external symptoms. This suggests that 
sometimes in man a miliary tuberculosis of the 
lungs may remain latent, and cause no symptoms 
until a catarrh, with foci of inflammation, sets up 
phthisis. 

A preliminary account of these experiments of 
Tappeiner led Dr. Max Schottelius to make 
some similar experiments, not only with the 
sputum of phthisical individuals, but also with 
that of persons suffering from simple bronchitis, 
and with pulverized cheese, brain and cinnabar. 
The result was that miliary tubercles were found 
in the lungs in all cases, and in equal quantity 
with both phthisical and bronchitic sputum. 
Cheese produced a smaller quantity; pulverized 
brain still less, and the cinnabar least effect of all — 
merely a few whitish tubercles with pigmented 
centres, with an interstitial deposit of the sub- 
stance, which had caused no inflammatory reaction. 
Tappeiner has also experimented with calves' 
brain in two cases, but with purely negative 
results. No changes in the lung followed, such as 
resulted from the inhalation of tuberculous sputum. 



Mollnscam Contagiosnm. 
Professor Bollinger, of Munich, considers the 
above disease to be due to gregarinae, and to be 
identical with an affection which sometimes 
attacks the comb of fowls. He believes he will 
be able to prove the relation of the so-called 
" molluscum corpuscles " to gregarinae. 



Notes and Comments. 

The Treatment of Lunacy. 
In a late article on this subject, Prof, Flemming 
details two methods. The first consists in the 
complete abolition of coercive remedies. With 
the discussion of this method most readers are 
perfectly familiar, through the works of Tuke, 
Connolly and others. The second is described 
as the narcotic method. Narcotics are used — such 
as hyoscyamus, small doses of opium, hypodermic 
injection of morphia, very small doses of atropine, 
either alone or combined with opium. Allied to 
these are such remedies as choloroform, bromide of 
potassium (which diminishes cerebral congestions), 
and hydrate of chloral. Attention is specially 
directed to the " hypnoticum " of Prof. Preyer, of 
Jena, which is a lactate of soda and acts as a cal- 
mative, Preyer believing that the accumulation of 
lactic acid in the normal brain is the cause of 
normal sleep. This remedy is administered in 
doses of five to sixteen grammes, by the mouth or 
rectum. This remedy, however is still on its 
trial. 



Stretching tke Facial Nerve for Convalsive Tio. 

A successful instance of this treatment is re- 
corded by Dr. Baum, in the Berliner Klin^ Wochen- 
schrift. The operation was performed on July 
20th, 1878, nearly six years after the first symp- 
toms of tic convulsif showed themselves. The 
nerve was reached by cutting down on the upper 
border of the parotid gland, with antiseptic pre- 
cautions, and drawing the latter, with hooks, down- 
ward, outward, and forward. The nerve was 
found of a dark-red color, but not sensibly thick- 
ened. Dr. Baum seized it with a torsion forceps, 
and squeezed it with some force, at the same time 
drawing it from its bed. A few small«irteries had 
to be tied before closing the wound. A temporary 
paralysis of the left half of the face, of half an 
hour's duration, followed the operation, but the 
twitchings did not return, nor had they returned 
at the time of the publication of the paper in 
October. 



Pyrogallic Acid in Haemoptysis. 

In the Dublin Medical Journal, for December 
last, Dr. A. Vesey speaks highly of this agent in 
haemoptysis, metrorrhagia and other internal 
hemorrhages. He says — 

Pyrogallic acid appears to me to have the fol- 
lowing advantages : The dose is small ; it does not 
disarrange the stomach in the way that the usual 
gallic or tannic acid mixtures do ; it does not cai^e 



84 



Correspondence. 



[Vol. xl. 



vomiting, as iron and ergot mixtures sometimes do ; 
it is easily taken, and has no disagreeable after- 
taste. It appears to be more rapid and certain 
than any of the remedies mentioned above, and far 
surpasses the time-honored acid infusion of roses, 
or pil. plurabi cum opio. It dissolves readily in 
water or in spirit. A spirit solution of definite' 
strength affords a convenient and ready method of 
administration. 



The Prolonged Daily Use of Salicylic Acid. 
In one of the German pharmaceutical journals 
Professor Kolbe, of Leipzig, relates his own ex- 
perience of the moderate use of salicylic acid for 
ar long time. He was dyspeptic, and often troubled 
with hepatic eruptions in and about the mouth, 
and as a remedy he tried salicylic acid, not in the 
form of a dose, but taking it in his water, wine 
and beer, greatly diluted, but reaching daily an 
average of fifteen grains. He reports, after nine 
months, that his health is excellent, his dyspeptic 
troubles vanished, and no ill effects whatever 
noticeable. Careful examinations of the urine 
showed no trace of albumen, alleged by some to 
follow prolonged use of the acid. 



The Microphone in Diagnosis. 

This will certainly become a most valuable 
addition to diagnostic apparatus. British journals 
state that Surgeon Major Wallich, of the British 
Army, has produced an instrument by means of 
which the heart sounds are not only greatly in- 
creased in intensity^ but remain quite distinct, the 
character of the two sounds being much intensified. 
By applying the microphone over the stomach 
©lie can hear the noise of water dropping into that 
organ from the oesophagus ; there is every reason 
it© hope that Dr. Wallich's improved instrument 
may be made available for the purposes of clinical 
demonstration. 



Successes of Antiseptic Surgery. 
Professor Volkmann, of Halle, relates {Samm- 
l ung KUnische Vortrdge, 117, 118) a series of 
seventy-five compound fractures treated during 
four years, by conservation under Lister's anti- 
septic method, without the loss of one patient. 
The result is the more remarkable that the frac- 
tures were in many cases into joints. In all cases 
the skin was shaved, soaped, washed, and cleansed 
with carbolic acid ; extensive effusions were 
incised and drained ; the wounds were enlarged 
with the bistoury, so that every corner could be 
cleansed with the carbolized stream of water; 
splinters were removed ; sharp points were taken 
off; and a large drainage tube was introduced 



down to the bone, but not between the fractured 
ends. The dressings were applied under the 
spray, and were at first changed every twenty- four 
or forty-eight hours ; afterward at longer intervals. 



The Quinine Rash. 
The eruptions produced in some persons by the 
use of quinine may, according to Dr. Farquhar- 
son, be divided into two classes. Those of an 
eczematous character, which are described by some 
continental authorities as occurring on the skin of 
workers in quinine manufactories. Those which 
follow the internal administration, usually of very 
small doses of the drug, and which may be either 
erythematous or rubeoloid in character. 



Correspondence. 



The Value of Chlorine in Diphtheria. 
Ed. Med. and Sukg. Keporter : — 

In the effort to popularize new methods of treat- 
ment, it often happens that an old and efficient 
remedy is forgotten. I was forcibly reminded of 
this a few months since, by a conversation with an 
esteemed professional neighbor. In speaking of 
the treatment of diphtheria, he remarked that he 
invariably used a chlorine mixture recommended 
in Watson's " Lectures on Practice," internally, and 
painted the neck and throat externally with tinc- 
ture of iodine. The doctor further remarked that 
he had no recollection of ever losing a case. 

This led me to make trial of the plan, and I find 
thus far that it is more efficacious than anything I 
had ever resorted to before. My cases have, how- 
ever, been mild, and I mention the matter trusting 
that some of your readers will give the plan a 
trial. Of course this treatment will not interfere 
with the use of iron, quinine, and general support- 
ing treatment, to obviate the tendency to death by 
asthenia. 

The mixture is prepared by adding two 
drachms of chlorate of potassa to a four-ounce 
mixture made of equal parts of muriatic acid and 
water, putting them into a bottle with glass stop- 
per, in a dark place ; two fluid drachms of this 
mixture to be mixed with a pint of water, and one 
tablespoonful given every two hours, diluted with 
water. For children less than six years old the 
dose may be proportionately reduced. 

Dr. Farnsworth is not far from correct; true 
membranous croup is difficult of cure. It is a 
wonderful thing to tell a mother her child has 
croup to-night, and find it well in a day or two. 
Still I think I have seen cases of genuine croup 
cured under the use of an active emetic at the 
commencement — calomel in small and oft repeated 
doses, until the stools are like chopped spinach — 
and the persistent use of the lime inhalations. 

Maryland, Jan., 1879. H. F. W. 

[The value of the chlorine mixture, both in 
diphtheritic and scarlatinal complaints, is un- 
doubtedly considerable, and perhaps not sufficiently 



Jan. 25, 1879.J 



Correspondence. 



85 



borne in mind. The mixture can be variously pre- 
pared. Three formulae, besides that given by our 
correspondent, are mentioned in the sixth edition 
of "Napheys' Therapeutics," (Nos. 1054, 1064, 
1065). Ed. Eeporter.] 



Instruments in Labor. 

Ed. Med. and Surg. Eepqrter : — 

On reading the communication of Dr. Corson, 
of Conshohocken, Pa., I was highly gratified to 
find that what I had long wished and hoped for 
had made its appearance. Dr. Corson's statements 
so perfectly accord with my experience and opin- 
ions, that I cannot command language sufficiently 
emphatic to express my approbation of them. I 
cannot but think that the teachings of many who 
seem to be men of eminence in the profession are 
pernicious, to a great extent, in regard to the fre- 
quent use of obstetrical instruments. In over 
twenty-six years of practice (rural) I have never 
yet witnessed a serious case of laceration of the 
perineum, nor a single case of vesico-vaginal 
fistula. If the former had occurred in any case of 
labor which I have had I should have known 
it at the time, and had the latter occurred as a 
result of any case of labor which I have had, I 
believe I would certainly have heard of it. 

My experience in this respect has not been an 
isolated one. I have attended, as accoucheur, 
hundreds of women who had in previous cases 
been attended by others, and I never heard one of 
them say that anything of the kind had ever hap- 
pened to them. Neither did I ever hear any of 
my neighboring physicians say that they had ever 
had anything of the kind happen in their prac- 
tice ; and when, not very long since, I read in the 
report of an eminent gynecologist the large pro- 
portion of these accidents, if accidents I may call 
them, I was perfectly astounded, and felt like ex- 
claiming, shameful^,! shameful ! The proportion of 
obstetrical cases I have had in which instruments 
were used, is about one in a hundred ; and I think 
that is about the proportion in which my neigh- 
boring physicians used them. W.. SiGSBEE, m.d. 

Mendon, III. 



On the Use of Deztro-Quinine. 
Ed. Med. and Surg. Eeporter : — 

Dextro-Quinine has given good results in the 
few cases which I have treated with it. It is a 
brown powder, being very light and not so bitter 
as quinine. Found it most pleasantly disguised 
with extract of licorice, but prefer to give it in 
wafer. The following cases seem to demonstrate 
that it is equal to quinine, and less liable to pro- 
duce unpleasant symptoms, such as ringing in the 
ears and sickness of the stomach. As to the dose, 
I have not sufficient experience with it, but it can 
be given in large doses without any inconvenience. 

Case 1. — William S., laborer, robust and strong. 
Commenced having chills last June, of the quo- 
tidian type ; in a few days were checked, by the use 
of quinine; the chills returned at short intervals, 
with increased violence; during this time was 
living in Kansas City. Saw him for the first time 
on December 16th (after having been exposed), 
with a congestive chill ; for three days previous he 



said he had an attack which was equally severe. 
The chill lasted two hours, followed by a high 
fever lasting six hours ; was delirious ; vomited 
freely ; tongue was clean. The chill commenced 
at 2 P.M., and as I wished to be positive as to the 
genuineness of the chill, and the effect of the new 
remedy, did not give any remedy until 5 p.m., 
when he took ten grains of dextro-quinine, and the 
following day four doses of ten grains each, com- 
mencing at 11 A.M. At two and half p.m. had a 
chill, but it was not near so severe, and the fever 
lasted only a short time. 

Dec. 18th, wishing to break the chill and test 
the value of the remedy in full doses, ordered ten 
grains every hour for nine doses ; the last four 
doses caused a little ringing in the ears, sickness 
of the stomach, with a sense of general weakness ; 
these symptoms only lasted a few hours ; had no 
chill from this time on. On the 18th commenced 
taking one grain three times daily, which was 
continued for two weeks. Appetite increased, felt 
well and strong, and no chill up to this date, Jan. 
13th. 

Case 2. — Mrs. Mary P. Labor pains inactive, 
worrying, and the patient growing weak ; ten grains 
of dextro-quinine had the desired eflTect of causing 
the pains to be active and efficient, seeming to 
have the same eflTect as quinine in like cases. 

Case 3. — Dr. McMahan gave five grains every 
two hours, for four doses, to one of his patients 
suffering with caries of the spine, with high tem- 
perature ; could not retain quinine or cinchonidia. 
The dextro-quinine was retained and gradually 
lessened the fever ; was not able to continue the 
remedy, as the ounce kindly furnished by Keasbey 
and Mattison had been exhausted. 

Quincy, III. L. A. Nickerson, m.d. 



The Introduction of Yellow Fever. 

Ed. Med. and Surg. Eeporter: — 

As the subject of yellow fever occupies a promi- 
nent place in the minds of physicians and laymen, 
and all are anxious for information, and for the 
discovery of its causes, treatment, or prevention, I 
hope you will give this a place in your Eeporter, 
which is read by so many thousands. 

The yellow fever epidemic in Texas, in 1867, 
was as fatal and more extensive than that ©f 1878, 
because it was not confined to this State, but 
spread far beyond; yet the public mind was 
not so aroused then as it was last year. And 
according to statements published by eye witnesses, 
the origin of that terrible epidemic was from a 
dray load of baggage brought from Vera Cruz, 
Mexico, to Indianola, Texas ; thence the infection 
was carried by steamers to Galveston, and thence 
generally diffused. 

Allow me, in this connection, to give the fol- 
lowing brief statement of an epidemic of yellow 
fever which scourged the inland town of Wood- 
ville, Miss., in 1844, but which epidemic is not 
enumerated by Dr. J. M. Toner in his tabular 
epitome of yellow fever. I was practicing then m 
Woodville, and write from personal observation. 
There was no yellow fever that year in New Or- 
leans, but there was in Galveston, Texas. 

In July a Methodist minister named Thurber, 
living in Texas, passed through Galveston, and 



86 



News and Miscellany. 



[Vol. xl. 



visited several persons there, sick with the yellow 
fever, which he had not had. He went from Gal- 
veston on a steamer, by way of the mouth of the 
Mississippi river, making a quick voyage, and on 
arriving in New Orleans, found a packet steamer 
ready to go up to Bayou Sara, on which he took 
passage, thence by railroad to Woodville ; the 
whole trip from Galveston to Woodville occupied 
about four days, not more. In less than forty- 
eight hours after arriving there he was taken sick 
with fever, and came very near dying. 

Dr. T. C. Brown attended Mr. Thurber, and was 
very much puzzled by the symptoms, as he had 
never seen a case of yellow fever. Several persons, 
both males and females, visited the sick man and 
nursed him nearly two weeks. In a short time the 
yellow fever began to spread, and during its preva- 
lence over two hundred victims fell before it. 
Physicians from New Orleans went up and pro- 
nounced it yellow fever. The infection was so 
virulent that scarcely a person who visited the 
place for a few minutes escaped, and many movers 
and travelers passing rapidly through town after- 
ward had the fever, and died in distant parts of 
Mississippi, Louisiana, and even in Texas. 

All my experience confirms me in the belief of 
the exotic origin of yellow fever, and that rigid 
quarantine should be established and enforced, as 
the only preventive. A. R. Kilpatrick, m.d. 

Navasota, Texas. 



A Case of Erysipelas. 
Ed. Med. and Surg. Eeporter: — 

Last Sunday afternoon I was called from 
church, in a neighboring village, to see a patient of 
a physician friend, of our own town. There is 
nothing unique or particularly striking to report, 
but from the case we two physicians gathered an 
important le^^son, and, thinking it might be pos- 
sible to extend the lesson to other brethren, I have 
penned this brief note. 

The Wednesday preceding the Sunday referred 
to, Mrs. C. was taken with a chill, Thursday 
erysipelas developed itself on each cheek, near the 
ears. Saturday Dr. T, was sent for, and treated 
her in the usual manner — iron, quinine, etc., and 
applied a cranberry poultice to the inflamed skin. 
Considering it an ordinary case, he felt no un- 
easiness, and left, with the word that he would see 
her the following morning. Within six hours the 
disease became violent, the inflammation rapidly 
spread, and the patient became comatose. The 
doctor did not see her Sunday morning, and in 
the afternoon I, being in the vicinity, was called 
in, as mentioned above. She was then com- 
pletely unconscious, and evidently near her end. 
Sending for Dr. T., he arrived only in time to 
find her dying. 

This case taught us that a prognosis of even 
apparently simple cases must be given guardedly. 
It also impressed us with the ease with which dis- 
ease sometimes destroys life, though we often see 
life continuing tenaciously, even in the midst of 
fearful diseases and conditions. Finally, it is 
safer to err on the side of frequent visits, even if 
some of them are made without expectation of 
remunerati'On, simply to keep one's self informed 
of the progress and tendency of the morbid ac- 
tion. C. C, Vanderbeck, m,d. 



News and Miscellany. 



Beware of Impostors. 

A genteel looking fellow giving the name of 
Wilson, canvassed Harrisburg, not long ago, for 
subscriptions to the Medical and Surgical Re- 
porter, calling on most of the physicians and 
druggists. He visited Dr. Seibert, at Baldwin, 
and during the tatter's absence a case of surgical 
instruments were stolen, and from another physi- 
cian he stole a copy of Napheys' Therapeutics. He 
was arrested in Lancaster, and returned to the 
chief of police at Harrisburg. 

We take this opportunity to say that we have 
no agent of that name, nor do we employ any one 
whatever to take subscriptions for us ; and when- 
ever we do commission a person for that purpose 
he is always furnished with written authority and 
letters of introduction. 



Notes on Novel Pharmaceutioal Preparations. 

COPAIVIC ACID. 

This is obtained in prismatic crystals, which, at 
first, are clear, but soon become opaque on ex- 
posure. It is obtained by distilling the balsam with 
water, to remove the ethereal oil, dissolving the 
resinous residue in refined petroleum, and re- 
peated washings with alcohol. It is stated to act 
with all the energy of the balsam and to be less 
nauseous, and hence, less apt to disorder the 
stomach. 

CHLORAL-CHLOROFORM. 

Chloroform made from chloral is sold in Ger- 
many at a considerably higher price than that 
manufactured in the usual way. It is asserted 
that it keeps better and is less liable to be followed 
by dangerous results. The leading manufactories 
of chloral have found the consumption of this 
latter drug to have fallen off greatly in the last 
year or two, so they employ their works in the 
production of this new form of the ansesthetic 

maltine. 
This is a preparation closely akin to extract of 
malt. We have watched its exhibition in several 
cases of anaemia, general exhaustion from over- 
work^ debility from advanced age, and threat- 
ened phthisis. Some patients found it difficult to 
overcome a repugnance to its flavor, but where 
it was taken regularly, it imparted a very desir- 
able stimulus to the function of nutrition. The 
pTeparation we have used is that made by Reed & 
Carnrick, of New York city, which we have every 
reason to believe is manufactured in the most 
approved manner. 

Medical Charities of Philadelphia. 

— In the hospitals of this city there are at 
present nearly 1200 empty beds. This testifies 
to two things : first, that the health of the city is 
good; and secondly, that medical charities are 
quite as extended as the needs of the city demand. 
In fact, we believe that any further addition to the 
hospitals or dispensaries of this city, except in on© 
or two special lines, would be a useless waste of 
money and an injury to the profession and tha. 
public. 



Jan. 25, 1879.] 



News and Miscellany, 



87 



Death of Dr. John B. Diddle, Dean of the Faculty I 

of Jeffarson College and President of Board 

of Prison Inspectors. 

Dr. John Barclay Biddle, Professor of Materia 
Medica in the Jefferson Medical College, Dean of 
the College Faculty and President of the Board of 
Inspectors of the County Prison, died at seven 
o'clock Sunday evening, at his late residence, 331 
South Seventeenth street. Dr. Biddle has been an 
invalid for the last four or five years, and took 
frequent trips to Europe to better his health. 
Two weeks ago he was attacked with a heavy cold, 
causing congestion of the lungs, which eventually 
brought on death. 

Dr. Biddle was the eldest of the sons of Colonel 
Clement C. Biddle, a Philadelphian by birth, 
born January 3d, 1815. Always inclining toward 
the medical profession, it was not long after at- 
tending schools in this city and graduating from 
the Baltimore St. Mary's College, that he entered 
the Medical Department of the Pennsylvania 
University, under the special instruction of Dr. 
Nathan Chapman. He left the University with 
honors, but did not at once begin practice. With 
Dr. Meredith Clymer he started the Medical Ex- 
aminer, about the year 1842. This journal, not 
now published, was a weekly periodical, devoted to 
medicine, and achieved success. Dr. Biddle, 
after a few years as editor, began upon practice, 
in which chapter of medical life he was best 
known. In 1844, in connection with Professor 
Joseph Leidy, Drs. Paul P. Goddard, David H. 
Tucker and Dr. Joynes, he founded the Franklin 
Medical College, which stood some time on Locust 
street, near Twelfth. All the supporters of the 
college gradually drew from it to other pursuits, 
and the college died out, but during its short 
career it graduated many students, who are now 
distinguished physicians. The position of Pro- 
fessor of Materia Medica in the Jefferson Medical 
College, in 1864, was considered one of distinction, 
and the chair being offered to Dr. Biddle, he 
accepted. Thrown into such a station. Dr. Biddle 
turned all attention toward a treatise on materia 
medica for students, which was accepted by the 
Faculty of the Jefferson College and reached an 
eighth edition. Soon after taking this chair Dr. 
Biddle was made Dean of the College Faculty, and 
continued both Dean and Professor uninter- 
ruptedly until death. 

A. W. Lneck, M.D. 

The following preamble and resolutions were 
unanimously passed by the Rock River Medical 
Society, at the meeting in Fond du Lac, Wisconsin, 
January, 8th, 1879, in memory of the late A. W. 
Lueck, M.D. : — 

Whereas, We have learned with sincere sor- 
row that death has removed from our midst our 
late esteemed friend and member, A. W. Lueck, 
M.D., of Mayville, Wisconsin, therefore, 

Resolved, That while we bow submissively to 
Him who doeth all things well, we yet sincerely 
deplore the early death of him whom we had 
learned to appreciate and love> for his pure and 
noble character and his unselfish devotion to the 
cause of science and suffering humanity. 

Resolved, That his professional enthusiasm and 
success have afforded unmistakable evidence of 



his fitness for the profession of his choice, and 
that his example is worthy of personal emulation 
by us all. 

Resolved, That we shall ever hold him in re- 
membrance for his genial social qualities, his 
unfeigned modesty and true nobility of soul, as 
well as for his professional integrity. 

Resolved, That our earnest sympathy be extended 
to his sorrowing family, upon whom the severest 
weight has fallen ; may they feel the tender care 
of the Hand that has wounded but to heal, and be 
cheered by the thought that the life that has gone 
out so early in darkness has even now entered 
upon an endless existence of joy. 

Resolved, That the Society be instructed to for- 
ward a copy of these resolutions to the family of 
the deceased and to the Medical and Surgical 
Reporter, for publication. 

N. Senn, 

W. P. Wenzel, 

E. J. Smith, Committee. 

Henry P. Wenzel, m.d.. Secretary pro tern. 

Theresa, Wis., January 9th, 1879. 



Madame Anderson's Walk. 

This extraordinary feat of endurance has at- 
tracted general attention lately. The following 
extract from the New York Sun has considerable 
medical interest : — 

" Madame Anderson is resting. That does not 
mean simply sleeping," said Physician J. G. Ros- 
man, of Brooklyn, last evening, in Dr. Shepard's 
Turkish bath establishment on Columbia Heights, 
Brooklyn, whither Madame Anderson was taken 
after completing her task of walking 2700 quarter- 
miles in as many quarter-hours. " It is not in 
human nature," the physician continued, " to un- 
dergo such a strain and to immediately sleep off 
the effects of it. The system needs light food at 
frequent intervals, and if the patient is in a healthy 
condition of body, then she will awake when she 
has all the sleep that she can stand. That is 
exactly what Madame Anderson has done, and 
there could possibly be no better proof that she is 
coming out all right. On waking up she has 
eaten the lightest and yet the most nourishing 
food, such as extract of beef and fruit jellies of all 
kinds. Her pulse has become regular, when 
asleep at 64 and when awake at 70. While a?leep 
she is as quiet as an infant, just as though she had 
not a nerve in her body, and when awake she is 
cheerful and calm. Her conversation is bright 
and her mind as clear as a bell. Her longest 
periods of sleep are about an hour and her longest 
intervals of wakefulness half an hour. That means 
that she is resting in the best way possible." 

Dr. Shepard said the theory of the treatment of 
Madame Anderson is to let her down gradually 
from the results of her effort, and to build up her 
strength as gradually. During the whole of the 
first night she was allowed to sleep only half an 
hour, and although she had then to be awakened, 
she awoke easily. At midday she dressed and 
took a Turkish bath. After the bath she slept 
again, and at night it was clearly perceptible that 
she had improved, even since morning. 

" The fact that we are surprised that Madame 
Anderson has endured so much and yet is recu- 
perating 80 rapidly," the physician added, " showsf 



88 



News and Miscellany. 



Vol. xl 



that we know very little, as yet, how much any 
perfectly sound constitution is capable of. She is 
evidently not of a muscular make-up, but her 
whole constitution, physical and mental, is in 
perfect equipoise. Her temper is of the sweetest, 
and that, without doubt, helps her to recover 
rapidly. Even in the last days of her walk, when 
she was awakened out of sleep that every atom in 
her body was crying out for, when she had no 
more voluntary control of her mind than she 
would have had if she had been deeply intoxi- 
cated, she uttered no petulant exclamation when 
her attendant, to startle her into effort, puffed a 
spray of hartshorn into her face." 



Prevalence of Diphtheria. 

This fatal disease has broken out in a severe form 
in the interior of this State, in New York city, and 
especially in Nova Scotia, in and around Halifax. 
Dr. E. M. Snow says of its appearance in Provi- 
dence, E. I. — 

In 1878, as in 1877, there was a large mortality 
from diphtheria, and the epidemic still continues, 
though evidently on the decline. In the three 
years, 1856 to 1858 inclusive, there were 652 
deaths from diphtheria in Providence, a mortality 
similar to that of some other cities in past years 
from the same disease, though not so great as in 
some of them. The disease has visited some other 
portions of the State with a greater proportional 
mortality than in Providence. At the present 
time it is prevailing with great severity in some 
of our towns. 

In Cincinnati the proportion was much greater, 
no less than twenty-seven per cent, of the 234 
deaths during the last two weeks of December 
being attributed to these affections, 51 to scarlet 
fever and 14 to diphtheria. Boston, Chicago and 
other cities show a similar prevalence of the 
winter scourge among children. 

In Philadelphia, during the fourteen weeks end- 
ing January 5th last, in 3949 deaths from all 
causes 154 were from scarlet fever and 173 from 
diphtheria. In the same fourteen weeks a year 
ago there were 3827 deaths from all causes, 134 
from scarlet fever and 175 from diphtheria. The 
close correspondence of these figures is remarkable. 
In the fourteen weeks ending with January 5th, 
1878, 1688 minors died; in this year 1710, an 
increase of 22, which is almost exactly covered 
by the increase of 20 in the deaths from scarlet 
fever. 



One Hundred and Two Tears Old. 

Miss Sophia C. Kemper died in Easton, Pa., 
January 19th, in the one hundred and second 
year of her age. She was born on August 15th, 
1777, at Morristown, N. J., and was a daughter of 
Colonel Daniel Kemper, an officer in the Conti- 
nental army. She came to Easton in 1796, and 
has resided there ever since. To the last she was 
bright and cheerful, and possessed of a clear 
memory and an unimpaired intellect. One of her 
brothers-in-law, Samuel Sitgreaves, was Minister 
to England under President Adams. Another was 
Bishop Jackson Kemper, of the diocese of Wis- 
consin. The family is noted for its longevity. 



Items. 

— Out in Ohio they paraphrase Scripture a little, 
and say. Where the body is, there will the 
snatcher be also. 

— Dr. Charles J. Overholt, of Indianapolis, was 
convicted of bigamy at Muncie, Ind., on .January 
18th. He was a prominent physician. He will 
serve two years in the penitentiary. 



QTJEBIES AND EEFLIES. 

Althorp, of Va. " Dr. Pierce, of Buffalo," whose 
preparations you inquire about, Is, of course, not 
recognized by the profession. His " Alterative Ex- 
tract, or Golden Medical Discovery," is a mixture 
of opium and lactu 'arlum in dilute sweetened al- 
cohol. His " Favorite Prescription," for diseases- of 
women, etc., is a mixture of savin, cinnamon, cin- 
chona bark, aniseed, digitalis, laudanum, and 
sweetened alcohol. They have been analyzed by 
Hager and others. 

Sangrado. Fresh blood has been often used as a 
remedy in debility, etc. Its value is doubtful. Ac- 
cording to Dr. J. Jeannel, it is difficult of digestion, 
slow of assimilation, imparts a fetid odor to the 
faces, and is in every way inferior to rare or raw 
beef, or beef tea. 

Dr. F. A.y of Pa. There is not a medif^al journal 
in the world which has continued for a century. 

Dr. Thomas P , of Ga. Any of the bo ks noticed 
In the Reporter, or, in fact, any medical books in 
the market, will be mailed you, postpaid, on remit- 
ting their catalogue price to this office. 



MARRIAGES. 



Austen— MuNROE.— On the 25th of Deceaiber, 1878, 
at tbe residence oi the bride's parents, by the Rev. 
Dr. J. C. Eccleston, Dr. P. fownseud Austen, of 
Rutgers College, New Jersey, and Eileu M., daughter 
of Thomas Munro ', Clifton, Staten Island. 

Harrington— Scott.— On Christmas afternoon, 
December 2oth, at the residence of the bride's 
mother, by the Rev. Mr. Haydeu, Dr. John Harring- 
ton, of Cedar Falls, Wis., and Louisa O. ttcott 

Humphreys— Kkyt.— Decern! er 24th, 187S, by Rev, 
Geo. M. Maxwell, d.d., at the residence of the bride's 
parents, Walnut Hill, Cincinnati, Ohio, William H. 
Humphreys and Rebecca, daughter of Dr. A. T. 
Keyt. 

Stevenson— EwiNG.— At Uniontown, Pa., January 
Isr, by Rev. S. S. Gilson, Dr. John J. Ste-veason, of 
New York, and Mary C, daughter of the late Na- 
thaniel Ewing, Esq., of Uniontown. 



DEATHS. 

DAVIS;— At Dent., O., suddenly, of gastric hemor- 
rhage, Hattie L., youngest child of Dr. E. F. and 
Mary M. Davis, aged 5 years and 5 mouths. 

Gardiner.— In thecity of Brooklyn, Jan 7th, 1879, 
attera lingering illness. Dr. William H. Gardiner, 
second sou of the late Nathaniel Gardiner, in the 
57th year of his age. 

Lawson.— Of diphtheria, December 12th, 1878. after 
a sickness of th>ree days. Kittle Bell, aged 3 years, 2 
months, and 4 days, daughter of Dr. T. C. and Mrs. 
A. E. Lawson,' of Greenville, Clarion Co., Pa. 

Martin.— In Phila., on the 3d instant, Dr. John 
Martin,, aged seventy-nine years. 

Miller.— At Nordhoff, California, December 22d, 
1878, Chat-les K. I. Miller, m.d., aged twenty-eight 
years. 





^ 



WHOLE No. 1144.] 



FEBRUARY 1, 1879. [VQi- xl, no. 5. "^ 



a?H: E 



MEDICAL AND SURGICAL 

EDITED BY D. G. BEINTON M. D. 



Terms of Subscription, FIT£ DOIiliARS per annum, in advance.— Sin;;;]e Copies Ten Cents. 



O O ]V TETVTS 



ORIGINAL DEPARTMENT. 

COMMUNICATIONS. 

CuRTiss, W. H,— Hepatic Abscess, with Notes of 
Three Cases 89 

Vance, Keuben A.— Inversion of the Human 
Bladder 91 

HOSPITAL REPORTS. 

Philadelphia Hospital— Surgical Clinic of Dr. John 
H. Brinton— Secondary Syphilis 94 

MEDICAL SOCIBTIES. 

College of Physicians, Philadelphia— An Endemic 
of Typhoid Fever, from Defective Drainage; 

Post-Mortem Emphysema 97 

EDITORIAL. DEPARTMENT. 
periscope. 

Remedies in Headache 101 

How to Give Electric Baths 101 

Poisoning from Sweet Spfrits of Nitre 102 

REVIEWS AND liOOK NOTICES. 

Notes on Current Medical Literature 102 

BOOK NOTICES. 

(cyclopedia of the Practice of Medicine (Von Ziem- 
ssen 102 

Half-Yearly Compendium of Medical Science ( Brin 
ton ) 103 

Physiology; Preliminary Course Lsctures (Whit- 
taker) 103 



An Introduction to Morbid Anatomy (Green) 103 

editorial. 
Late Discoveries Regarding the Nature o:f 

Contagion 104 

notes and comments. 
Bills Presented, and a Few Words About Them . . 105 

Resections of the Knee 105 

The Laws of Therapeutics ; 106 

Health Resorts in Egypt 106 

Trichina in American Pork 107 

Curare in Epilepsy 107 

CORRESPONDENCE. 

The Management of Puerperal Convulsions (Scott) 107 

The Treatment of Lupus ( Alexander) 107 

The Prevention of Consumption (Hutt) 108 

Remarks on the Rubber Ball Pessary (a. a. g.) 108 

Cysto-Sarcoma (?) of Ovary (Blackwell) 109 

NEWS AND MISCELLANY. 

Philadelphia County Medical Society 109 

Value of a '• Mad Stone" 109 

Obituary Notices 110 

Sanitary Protection h ssociations 110 

The Plague in Europe 110 

Consumption of Alcoholics 110 

Vital Statistics of London j^,^ 110 

Items C/^X- 110 



Marriages and Dkaths ./.^. .^^ — -. .^^.. 



Established in 1853, by S. W. BUTLER, M. D. 



PHILADELPHIA: 
Published at No. ^5 South Seventh Street. 




110 



^ 



Wm. F. Fell & Co., Printers, 733 Sansom St., Philadelphia. 



REMITTANCES RECEIVED. 

Week Ending January 25, 1879. 

N. B.—All Checks and P. 0. Orders must be drawn 
payable to the order of D. G-. Brinton, m.d. 

4®=- Subscribers are requested to inform us immedi- 
ately if their remittances are not acknowledged in this 
column. 

Alabama.— Br. F. M. Peterson. Arkaw^as.— Dr. S. R. 
Lanhon, California.— Dr. B. M. Alford. Colorado.— 
Dr. J.Hawes. Connecticut.— Dr. G.H. Atwood. Dis- 
trict of Columbia.— Dr. J. Scholl. Georgia. — Drs. C. 
H. Hall, G. W. Thomas, J. E. Bell, A. R. Taylor. 
Illinois. —Dr?.. N. S. Marshall, J, W. Hensley, A. 
Wiericb, W. H. Cook, J. G-. McKlnney, Southern In- 
sane Hospital. Indiana.— Drs. E. .T. Wilson, E. T. 
Spotswood, W. C. Chafee, H. S. Wolf, A. R. Byers, 
M. H. Rose, J. W. Runcie, Iowa.— Drs. G. S. Focht, 
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MEDICAL AND SURGICAL REPORTER. 



No. 1144.] 



PHILADELPHIA, FEB. 1, 1879. 



[Vol. XL.— No. 5. 



Original Department, 



Communications. 

hepatic abscess— with notes of 
three cases. 

BY W. H. CURTISS, M.D., 
Of Wilmington, 111. 

Having read with much interest the numerous 
papers upon the subject of Hepatic Abscess that 
have recently been presented to the profession 
through the medium of the medical journals, 
and notably those of Prof. Hammond, of New 
York, and Dr. Coles, of St. Louis, I am tempted 
to add my mite of evidence in favor of the ground 
taken by Prof. H. , by giving the history of three 
cases of this disease that have come under my 
care within the last three years. Two of these 
cases were undoubtedly proper ones for aspira- 
tion, and while the still more heroic treatment 
finally adopted admits of some doubt as to its 
propriety, I am still inclined to think that ''the 
end justified the means." Of this, however, I 
leave the profession to judge, confident myself 
that the dangers to be encountered by an evacu- 
ation of the abscess by means of the aspirator or 
by free incision are infinitely less than the 
dangers of septic poisoning — peritonitis — bron- 
chitis, or any of the other unpleasant sequelae 
that often follow the expectant plan of treat- 
ment. 

Case 1. — G. S., aged 24, of intemperate habits, 
was taken suddenly ill after a prolonged debauch, 
during which he was subjected to the tender 
mercies of a couch by the wayside on a stormy 
night, and when seen the next day was found 
to be suffering from high fever, intense headache, 
and severe shooting pains in the region of the 

89 



liver, and extending thence to the right scapula. 
The bowels were somewhat constipated, stomach 
irritable, abdominal parietes sensitive, especially 
over right hypochondriac region. The diagnosis 
of acute hepatitis was made, and the patient 
ordered eight grains hydrarg. sub-chlor., as a 
cathartic, tr. digitalis and tr. aconite, to con- 
trol the fever and rapid pulse, with free use of 
broken ice, by the mouth. The pain was re- 
lieved from time to time by hypodermic injec- 
tions of morph. acetas. The medicine seemed 
to operate well, but failed to cut short the dis- 
ease, which ran a rapid course. At the end of a 
week fluctuation could be made out near the 
costal extremities of the seventh, eighth and 
ninth ribs. On the tenth day of his illness he 
was taken with a severe rigor, followed by hectic 
fever and low, muttering delirium, indicating-^ 
the absorption of the purulent matter. 

He was now placed upon quinia sulph. and 
tr. ferri chlor. , in liberal doses, together with 
nourishing diet, and stimulants, in form of egg- 
nog, etc. Notwithstanding the best of nursing- 
he grew rapidly worse, and when seen on the 
fifteenth day of his illness his condition was ap- 
parently hopeless. The abscess now formed a 
distinct fluctuating mass, with, at the costal 
extremity of the ninth rib, a faint rose-colored 
spot, the size of a half-dollar, indicating a ten- 
dency to point at that place. The patient's con- 
dition, however, Avas such that it was evident 
death would ensue before a voluntary evacuation 
of the abscess would take place. 

Trusting that adhesions had taken place be- 
tween the liver and the peritoneum sufficient to 
permit an escape of the pus into the abdominal 
cavity, I decided to evacuate the abscess by a 



90 



Communications. 



[Vol. xl. 



free valvular iueisiou. This was accordingly 
done, and about two quarts of pus tinged with bile 
and hepatic debris was5 allowed to escape, greatly 
to my patient's relief, who soon sank into a quiet 
slumber, from which he awoke rational and every 
way much better. 

The septic symptoms did not immediately sub- 
side, but gradually disappeared under the quinine 
and iron treatment, combined with liberal nourish- 
ment. The abscess continued to discharge for 
several weeks, when the incision healed kindly 
and the patient made a good recovery without an 
untoward symptom. 

Case 2. — Hattie P. , aged fifteen. Native Ameri- 
can. Ill for several weeks. When first seen com- 
plained of severe pain in the epigastric region, of 
a lancinating character, accompanied by nausea 
and vomiting, chills, fever, headache, etc. Bowels 
constipated, urine scanty and high-colored, con- 
taining small quantity of bile. Sclerotic quite 
yellow, skin moist and clammy. Says she was 
usually well until about three weeks ago, when 
she was taken quite suddenly with a pain in right 
side, which has become more and more intense 
until now it is hardly bearable. Did not have 
any chills and but little fever, until ten days ago. 
Respiration rapid and superficial, tongue furred, 
pulse 130 and thready. On palpation left lobe 
of liver is found much enlarged, reaching nearly 
to the umbilicus, with distinct fluctuation below 
ensiform cartilage. Right lobe somewhat en- 
larged and very sensitive. Diagnosis hepatic 
abscess. To have quinine, iron, beef tea, with 
morphia and ice, to quiet pain and vomiting. 
Also to have poultice of linseed meal to epigastri- 
um. Patient grew rapidly worse, and on the third 
day from institution of treatment the outlook was 
so bad that, although there were no indications 
of pointing, I decided to evacuate the abscess, as 
the only chance of success. I accordingly made 
a free incision immediately below the ensiform 
cartilage, which was followed by a profuse flow 
of pus and the escape of a mass of partially de- 
composed lumbricoid worms. The patient made 
a good recovery. 

Case 3. — In June of the present year Mrs. W., 
aged sixty-two, came to my office complaining of 
paroxysms of severe pain, lasting for several 
hours, at intervals of from one to six days. 
These attacks were always preceded and accom- 
panied by rigors and fever, and usually by nau- 
sea and vomiting. 

She had been treated by numerous physicians 
for "fever and ague," and, as she claimed, had 
taken " barrels of medicine " without any relief, 
and had arrived at the conclusion that her trouble 



was not from fever and ague, but from something 
else. Patient was weak, anaemic, considerably 
jaundiced, urine of low gravity, of the color of 
porter, and depositing heavy brick- dust sediment. 
Bowels constipated, stools clay-colored. Liver 
somewhat enlarged and tender ; its exact condi- 
tion could hardly be made out, owing to a cica- 
trix over right lobe, occasioned by a hepatic 
abscess when sixteen years of age, for which she 
was treated by a surgeon in England, her native 
home. According to her account, the surgeon 
who thus attended her (forty- six years ago) had 
urged the necessity of opening the abscess with 
a lance, but permission not being granted him, 
it was allowed to open voluntarily, being aided at 
the last moment by the patient herself, through 
the instrumentality of a needle, when a gallon 
of pus and a quantity of calculi escaped, much 
to the patient's relief. With the exception of 
occasional colicky pains, similar to her present 
trouble, she has enjoyed good health ever since. 
On the day following her visit to my office I 
was called to visit my patient at her home. I 
found her in excruciating pain, covered with a 
cold, clammy sweat, much nausea, etc.; in short, 
the diagnosis of hepatic colic was easily made, 
and a full dose of morphia sulph. hypodermi- 
cally was administered, together with moist heat 
externally, which after a little relieved her suf- 
fering. Various plans of treatment were tried 
in the intervals of these attacks, which were of 
frequent occurrence, but little or no benefit was 
derived, except from the tonics indicated by her 
enfeebled condition. 

On Oct. 15th my patient was taken with an 
unusually severe chill, followed by hectic fever 
and severe pain in epigastrium, which was par- 
tially relieved by full anodynes. From now on 
her condition grew rapidly worse, and when seen 
on the 18th the skin was deeply jaundiced, with 
great pruritus, sclerotic yellow, liver much en- 
larged, extending four inches below the ribs, and 
quite sensitive to the touch. Upon consultation 
with my friend, Dr. E. R. Willard, of this city, 
my diagnosis of hepatic abscess, from obstruction 
by calculi or other causes " to the jury un- 
known," was confirmed, and we decided to put 
the patient upon liberal doses of muriate am- 
monia, arsenious acid, and quinine, with beef tea, 
egg-nog, etc., ad libitum. On the 24th the con- 
stitutional effects of the arsenic were manifested 
in the swollen eyelids, and this remedy was 
omitted. On the 25th, the case was complicated 
by purpura hemorrhagica, which first made its 
appearance upon the forehead, extending thence 
over the face, upper]extremities, body and limbs. 



Feb. I, 1879.] 



Communications . 



91 



until, on the 27th, the whole person was covered 
by the effusion. 

Fearing hemorrhage from the mucous mem- 
branes, I ordered full doses fl. ext. ergot and 
aromatic, sulphuric acid, which checked the 
hemorrhage, and at the end of a week all traces 
of it had disappeared. Her general symptoms, 
meanwhile, offered little encouragement. The 
chills were more frequent, pulse frequent and 
weak, slight delirium and great depression of 
spirits indicated septic poisoning, and rendered 
the prognosis very bad. 

On the morning of the 20th patient said she 
felt something "give way" in her side, and soon 
after she expectorated a quantity of offensive, 
green, very bitter matter, after which she ex- 
pressed herself as feeling much better. She con- 
tinued to expectorate this matter for several days, 
its green color gradually changing to a "creamy." 
Her appetite now returned, and in ten days, with 
generous diet, iron and quinine, she was able to 
be up. ' On the 15th of November she had 
another chill and a renewal of the pain and ten- 
derness over the liver, suffering severely, until on 
the 18th she vomited a quantity of matter similar 
to that she had before expectorated, and with the 
same relief to all bad symptoms. In a few days 
she was again up and has continued to improve, 
until now she says she feels better than for years. 

The causes of hepatic abscess have not as yet 
been determined with certainty ; indeed, Flint 
goes so far as to say, in his "Practice," that they 
may be considered spontaneous in a majority of 
cases. Notwithstanding the great learning of 
this author, I am not prepared to adopt this 
view, but prefer to cling to the time-honored 
axiom that there is "no effect without a cause," 
and were the exact pathological conditions of 
hepatic abscess well understood, I think they, as 
Avell as all other local inflammations, would be 
found to have an adequate cause. In the fore- 
going cases the exciting cause was evidently of a 
different nature in each. Case one, occurring in 
an habitual drunkard, the liver may reasonably 
be supposed to have been in the diseased condi- 
tion usually found in such persons ; and the ex- 
posure to a drenching rain during the night follow- 
ing an unusually hot day in July would comprise 
the conditions we should naturally expect to pro- 
duce an acute inflammation, and the liver being 
the weakest portion of the economy, upon that 
organ the disease expended its force. 

Case two was evidently one of those supposedly 
rare cases in which a number of ascaris lumbri- 
coides had migrated from the intestines into the 
hepatic ducts, and by the irritation caused by 



their presence in this organ produced a trau- 
matic inflammation. 

Case three may also be considered as of trau- 
matic origin. Although no calculi were seen, 
the evidences of their presence were unmistak- 
able, in the attacks of hepatic colic that were of 
such frequent occurrence before the formation 
of the abscess, and in the jaundice, which is not, 
I believe, a usual accompaniment of this disease. 

The fact of there having been a previous abscess 
of like nature, in which the calculi were seen, will 
go far toward establishing the diathesis, and 
their not being detected in this instance was 
probably due to the proper means not being 
employed. 

Undoubtedly the functions and pathological 
conditions of the liver are less understood than 
of any other organ of the body, with perhaps the 
exception of the brain, and for this reason it has 
so long been used by charlatans as a scapegoat 
upon which to pack their wares, and the still 
more weighty loads of their ignorance. 

Probably two-thirds of the chronic cases that 
come to our offices, if allowed to tell their stories, 
will tell you how Doctor so-and-so said they had 
' ' liver trouble. ' ' Possibly Doctor so-and-so may 
be right, but "trouble" is a very indefinite desig- 
nation upon which to base an intelligent plan of 
treatment. I, for one, am glad to see some of the 
old superstitions in medicine being done away 
with, and among them that of the rarity of 
hepatic abscess in temperate climates. The ex- 
tremes of temperature, sanitary condition and 
modes of life, in our middle temperate zones, 
are just such as we should a priori expect to 
produce acute inflammations of the liver as well 
as of other organs, and the thanks of the pro- 
fession are certainly due Prof. Hammond for his 
labors in the direction of a rational mode of 
treatment thereof. 



INVERSION OF THE HUMAN BLADDER. 

BY REUBEN A. VANCE, M.D., 
Of Gallipolis, Ohio. 
My attention was first called to the following 
case by the father of the patient, who called on 
me for advice, in November, 1877. His account 
was so obscure that I did not suspect the nature 
of the case, and declined to prescribe until I 
C3uld see the patient. On Dec. 7th he returned, 
with his wife and the infant. When the genital or- 
gans of the latter were exposed, a small, purplish- 
brown tumor, the size of a small hen's egg, was re- 
vealed, which, on closer examination, was found 
to spring from the upper and inner margin of the 



92 



Communications. 



[Vol. xl. 



orifice of the urethra. Externally, the tumor 
was pear-shaped, and when compressed between 
the fingers was elastic and resistant. It could 
be elevated without difficulty, thus exposing the 
lower part of the ostium "vaginse, and when lifted 
away from the body in this way, its pyriform 
shape was exceedingly well marked. On using 
a probe to determine the relation of the tumor 
to the urethra, th6 orifice of the latter was found 
to encircle the neck of the former. That is, the 
probe revealed no attachment between the neck 
of the growth and the walls of the urethra, for a 
distance of nearly two inches. The probe, while 
free to enter thus far above, below, or on either 
side of the tumor, could not be made to pass 
further into the bladder. At this point in my 
examination the child cried violently, and at each 
gasp the tension and prominence of the tumor 
could be felt to increase. 

Desisting temporarily from my exploration, I 
noted the following points in the history of the 
case. The girl was then (Dec, 1877) in her 
twenty- second month, and had suffered from 
dribbling of urine since she was a year old. The 
constant flow of this excretion caused excoria- 
tion of the lower part of her body and the inner 
aspect of her thighs, and necessitated frequent 
change of napkins. Shortly after this symptom 
developed, the mother said she observed some- 
thing filling \\\) and projecting from the water- 
2Dassage. Watching the parts daily, she soon con- 
vinced herself that the baby's incontinence of 
urine arose from something growing out of the 
urethra, and she consulted several physicians as to 
the nature of the growth. From the latter she 
learned that polypi grew from such places, and 
it was with the view of having the polypus re- 
moved that her husband originally came to con- 
sult me. The mother also stated that she had 
passed a wire (a smooth knitting needle) into the 
urethra when exploring the parts ; that it invari- 
ably made the baby cry, and crying caused the 
tumor to enlarge and protrude. In October, 
1877, she saw that a small part of the growth 
projected, even when the child was quiet ; and 
shortly afterward, when endeavoring to trace the 
extent of the growth, the child became excited, 
screamed violently, and bore down with so much 
force that the tumor suddenly enlarged to the 
present bulk. At times it suddenly diminished 
to the size of an acorn, but it never resumed its 
former small dimensions, and never receded 
within the urethral canal. 

While the mother was detailing these facts, the 
child gradually ceased sobbing and crying — it 



had screamed incessantly from the moment the 
parents first started to expose the diseased part — 
and this, too, while I continued to manipulate 
the growth and adjacent structures. As the 
child grew quiet, the tension and prominence of 
the tumor seemed much less than before, and 
this change in the characters revealed to the 
sense of touch w^as accompanied by a decided 
alteration in color. From a purplish-brown 
hue, the growth changed to a yellow tint. Also, 
an indistinct feeling of fluctuation attracted my 
attention to the part, and as I renewed my ex- 
amination, the child again commenced to scream ^ 
and cry. The tumor at once grew tense and \ 
hard, and became of a deep purple color. What- 
ever trace of fluctuation there might have been 
before disappeared with the first forced expira- 
tion. Quite a quantity of fluid bedewed the 
parts, but as I had no other thought than that 
it came from the meatus urinarius, I neglected 
to search for any other origin. Requesting the 
mother — who was supporting the child in a semi- 
erect posture before me — to quiet her babe, I I 
explained to the parents my idea of the case : 
That the tumor was a polj^pus developed from 
the mucous membrane of the urinary passages 
at some point near the junction of the urethra 
and bladder ; that it was the development of the 
former which caused the incontinence of urine, 
and that the incontinence now present de- 
pended upon relaxation of the urethra and con- 
traction of the bladder. Contraction of the 
vesical walls accounted for the fact that 
the probe passed but two inches, or such matter, 
from the meatus — a condition which I explained 
by the dependent position of the tumor — and the 
fact that it rendered the urethral canal patent, 
thus permitting the urine to escape as soon as 
carried into the bladder. I advised the parents 
to have the child operated upon, and I explained 
the procedures necessary to pass a ligature 
around the neck of the growth, near its origin. 

In order to determine the attachment of the 
tumor, I had the parents support the child 
while I examined the parts through the rectal 
walls. Passing my right forefinger to its full 
length into the rectum, I carried its pulp as near 
the junction of the bladder and urethra as I 
could — a method of examination peculiarly avail- 
able in infants. Inserting a small female catheter 
as far as possible along the urethra, I placed a 
finger on the base of the tumor, and at the same 
time carried the point of the finger in the rectum 
toward the supra-pubic region. Despite the fact 
that the child was screaming its loudest, a<nd 
struggling with all its might, the tumor, ordi- 



Feb. I, 1879.] 



Communications . 



93 



narily tense and resistant under such circum- | 
stances, became suddenly so soft and yielding 
that I directed the father to so move the child's 
hips that I could see the growth. To my great 
surprise I found that my finger had indented the 
tumor, as it would a soft rubber ball. Releasing 
the catheter I grasped the growth with my left 
hand, and as I compressed it, it slowly collapsed 
and began to recede within the urethra, and as 
it disa23peared externally, my finger in the rec- 
tum could feel an increase in the bulk of the 
structures in the vesical region. At this time 
the child's hips were elevated above its trunk; 
directing its father to lower still more its head 
and shoulders, I elevated its hips as I compressed 
the slowly diminishing growth. Finally, as the 
last of the tumor entered the meatus, I followed 
it with a catheter, and found no difficulty in en- 
tering the latter between three and fpur inches. 
While the child was kejDt in position, with its 
shoulders depressed and hips elevated, I made a 
careful inspection of the urethra, and found the 
canal greatly enlarged — enlarged to such an extent 
that I readily inserted the first phalanx of my 
little finger into its orifice — and its tissues so re- 
laxed that they scarcely contracted on my finger. 
Yet the tumor had disappeared, and no trace 
of it was to be found. With the child before me, 
I re-examined the parts, and carefully reviewed 
every point in the case. 

My first idea, that the tumor was a polypoid 
growth from near the junction of the urethral 
and vesical cavities, was no longer reconcilable 
with the facts. Despite its seeming impossibility, 
the only tenable surmise was that the bladder had 
been turned inside out. The impossibility of 
inserting a catheter while the tumor protruded, 
together with the absence of evidences of vesical 
•distention, or even of the presence of that organ 
in its proper position, and the continual dribbling 
of urine, contrasted with the ease with which a 
catheter could be inserted when the tumor was 
reduced, the immediate development of such 
tactile phenomena as denoted the return of the 
bladder to its position, the complete disaj^pear- 
ance of the tumor, and the sudden cessation 
of urinary dribbling, were arguments that could 
be answered in no other way than by supposing 
the bladder to have been inverted. I at once 
explained my change of opinion to the parents, 
and inquired as to their knowledge of any previ- 
ous reduction of the protrusion. The mother 
was certain that it had not receded within the 
meatus since October. When I inquired about 
the child straining in defecation, etc., they in- 
formed me that nothing was thought of the first 



development of urinary incontinence, for the 
child was suffering from whooping cough, and 
coughed with great violence. I imagine the 
parents were surprised at my sudden change of 
opinion, but when they learned that no operation 
would be necessary, they were not disposed to be 
critical. The child has had no return of its trouble, 
and in July, 1878, was perfectly well. An ac- 
count of this case apj)eared in the American Jour- 
nal of the Medical Sciences, for October, 1878. 

Prior to the day the above case came into my 
hands I had never heard of inversion of the blad- 
der. In searching for some record of similar 
cases I found, in the American Journal of the 
Medical Sciences, a brief- notice of the fact 
that Mr. John Croft, f.r.c.s., had published an 
account of certain ' ' Cases of Inversion of the 
Bladder," in the 2d volume of the St. Thomas" 
Hospital Beports, and upon communicating with 
that gentleman, he very kindly sent me a copy 
of his paper, from which I have abstracted an ac- 
count, not only of his own case, but of the three 
other examples of vesical inversion vv^hich he had 
collected. The following is Mr. Croft's account 
of his own case: — 

''On going to my out-patient room at St. 
Thomas,' on May 20th, 1870, 1 was hurried to see 
an infant in a sad plight. I was informed that a 
tumor from the vagina had burst, and was 
bleeding. The little sufferer, who was only four- 
teen months old, was crying and struggling. On 
examination I found a red, vascular, pear-shaped 
projection between the labia, about the size of an 
ordinary walnut. The mother stated that this 
had been down for four hours. It became evi- 
dent, on careful scrutiny and handling, that this 
was not of the nature of a polypus, or solid tumor, 
but the surface seemed to be formed by a mucous 
membrane, probably that of the bladder. It was 
tense with fluid. On turning this tumor from side 
to side and about, the vaginal orifice and hymen 
were distinguished posteriorly, but the lateral 
attachments were difiicult to uncover. I was in 
the act of inserting a little finger through the 
anus, when a violent struggle was made, and the 
tumor burst, upon its prominent front aspect, at 
a tiny spot, and a fountain of clear, straw-colored 
serum played for a few seconds, and then the 
tumor partly collapsed. A very small clot of 
blood formed at the seat of rupture. The mucous 
character of the surface was now apparent. I 
did not see the orifices of the ureters, but I should 
say that I did not pull down the sac for the pur- 
pose of exposing them. While trying further to 
examine the case, the collapsed sac partly re- 
filled, and the crying and struggling of the infant 



94 



Hospital Reports. 



[Vol. xl 



caused more of the fluid to be ejected; and more 
than once. Mr. Stewart, the curator of the Mu- 
seum, was present at this time, and took some of 
the fluid to test and examine microscopically. 
Meanwhile chloroform was administered. Under 
the influence of this, defecation and violent 
straining occurred. In order to prevent mischief 
from these efforts, I kept my thumb and finger 
pressed against the now collapsing sac, and found 
it gradually reducing in volume and receding ; 
as insensibility became complete, the little 
finger easily returned the remainder of the tu- 
mor through the meatus urinarius and urethra. 
I did not pass the finger through this passage, as 
I might have done, to explore, but inserted a 
director, which moved freely, as though in a 
bladder. I felt no doubt, from that time, the case 
was one of bladder turned inside out, through the 
meatus. To my inquiries the mother stated that 
the tumor had been down for four hours, and 
that it had been noticed more than once before. 
Three days back it had been down for half an 
hour, and went up during sleep. She had ob- 
served a difficulty in urination, and dribbling, 
during about two months. The mother said the 
infant's bowels had been habitually costive. 
After reduction the case was admitted into the 
hospital to be watched, on the supposition that 
during the state of inversion the bladder had 
ruptured, and that mischief might radiate from 
the seat of lesion. Mr. Stewart's examination of 
the fluid tended to support me in the opinion 
that the bladder had ruptured. He informed me 
that when he had evaporated some of the fluid 
on a glass slide to within a little of dryness, it 
turned yellowish (like a serous fluid), but there 
was not any crystalline appearance ; that on the 
addition of nitric acid no change took place, and 
there was not any indication of uric acid ; that 
when this had been a little further evaporated, 
ammonia was added, but no change was observed, 
no color developed — there was no sign of mu- 
roxide. After admission no bad symptoms en- 
sued. The urine flowed away so freely that it 
was not even necessary to keep a catheter in the 
bladder. On the third day, as the child seemed 
pretty well, the mother was allowed to take her 
out. The water continued to dribble away, and 
to be expelled on coughing, etc., for a few days, 
but soon almost complete control was regained 
over the urethra and meatus. In July, 1871, the 
mother reported that there had not been any re- 
lapse of the inversion, but that occasionally drib- 
bling occurred, and sometimes, during coughing 
or sneezing, a gush of urine took place." 

{To be Continue^.) 



Hospital Reports, 
philadelphia hospital. 

SURGICAL CLINIC OF DR. JOHN H. BRINTON. 
REPORTED BY DR. W. M. ANGNET. 

Secondary Syphilis. 

Gentlemen : — I propose this morning, to direct 
your attention briefly to a groujj of cases which 
excellently illustrate the onset or development of 
Secondary Syphilis. Let me premise, by re- 
minding you that syphilis is usually divided into 
three grades or forms — primary, secondary, and 
tertiary. By 'primary syphilis, we mean the in- 
fecting chancre, and the inflammation and indu- 
ration of the lymphatic vessels, and the nearest 
group of lymphatic glands ; thus, if the chancre- 
be upon the genital organs, the inguinal enlarge- 
ments, or bubo, would form part of the primary 
symptoms. Under the term secondary syphilis, 
we include the fever which precedes the attack of 
the eruption, known as syphilitic fever ; and the 
affection of the skin and mucous membranes and 
their appendages, and also certain lesions of the 
eye and of the testicles. In tertiary syphilis the 
fibrous and hard tissues are attacked, as the bones, 
joints, cartilages, and also the viscera and ner- 
vous system. Deep ulcerations of the tegument- 
ary system are usually embraced in this classifi- 
cation. The dividing line between the secondary 
and tertiary forms of the disease is, however, a 
somewhat arbitrary one, groups of symptoms 
being constantly observed, as I shall show you. 
presently, which with propriety may be referred 
to either. 

With these remarks, let us turn to the exam- 
ination of our cases. Here is a girl, M. S., 
about twenty years of age, who gives, us the fol- 
lowing history : Some three months ago she 
contracted a chancre on the vulva, which was 
not treated ; this was followed by enlargement 
of the inguinal glands, without suppuration^ 
These indurations, or kernels, as she calls them,, 
gradually lessened in size, and ceased to attract 
her attention. She then thought herself well, until 
within a week or two, when the eruption which 
I now show you made its appearance, and for 
this she seeks the shelter of the hospital. 

The eruption which she has is the roseola of 
syphilis, and when I examine her carefull}^, I find 
I can develop other symptoms which you will 
do well to note. The roseloa you see. She has 
in addition post- cervical adenitis and alopecia, 
and she has had syphilitic fever. We will now 
go back a little in the history of her case, and 
trace the march of the syphilitic invasion. First 
of all, we had the chancre — the infecting, or in- 
durated, or Hunterian chancre — with its accom- 
panying induration of the lymphatic vessels and 
inguinal glands. Then followed a period of" 
repose, and this has often been spoken of as the'^ 
period of secondary incubation ; the interval be- 
tween the primary development and the out- 
break of the secondary, or constitutional form of 
the disease. 

In the case of this woman, the time of second- 
ary incubation was about two months, and then 
followed the eruption, preceded, however, bythes 



I 



Feb. I, 1 879. J 



Hospital Reports. 



95 



stage of syphilitic fever. Slie tells me that be- 
fore the spots came out she had creeps and chills, 
followed by headache and fever, and that she suf- 
fered from pains flying about her, in her shoul- 
ders, and back, and loins, and in her extremities, 
and that the pains were so bad she could not 
sleep. These conditions indicate the existence j 
of this syphilitic irritation or fever. It is easily 
recognizable, and with a little practice yoil can note 
as you pass through the wards, those patients who ! 
are its subjects. The wan, uneasy, sallow, deject- j 
ed, and feverish appearances, are almost path- 
ognomonic. The pains which accompany syphi- ! 
litic fever are usually shifting, and paroxysmal, j 
sometimes aggravated at night — nocturnal pains | 
as they are called. Generally there is no local j 
lesion sufficient to account for them ; occasion- 
ally, however, there is. Here, for instance, is 
another girl, aged 21, who had a chancre two 
months ago, and has had a roseola upon her 
body and extremities for two weeks, accompanied 
by falling out of her hair. On her face the eruj^- 
tion is papular, with here and there shining vesi- 
cles. She is just emerging from a severe attack of 
syphilitic fever, and a very prominent feature in 
her case has been the presence of the osteoscopic 
pains, especially in her right arm, just above the 
elbow. You notice, as I raise the limb, the 
swelling of the part. When I feel it, it is very 
hard and exquisitely painful. At first sight, you 
might be deceived and suspect an injury. Yet 
there is here only one evidence, or outward 
visible sign of syphilitic fever, and she "tells me 
that this is now decreasing and becoming more 
bearable. These inflammatory effusions occur- 
ring in syphilitic fever, although occasionally met 
with, are still not very common. You will there- 
fore do well to bear in mind their possible pres- 
ence. They will ordinarily disappear under 
local antiphlogistic measures, combined with 
the proper constitutional treatment. 

In both of these women I find an enlarge- 
ment of the glands upon the back of the neck. 
In nearly all cases of constitutional syphilis 
there is at the outbreak a tendency to what is 
known as indolent engorgement of the lymphatic 
glands. That is, the glands generally in the 
body show this tendency to engorgement. You 
must not confound this state of affairs with the 
induration present in those glands in continuous 
anatomical relation with the primary sore, as the 
inguinal glands, when chancre of the penis or 
vulva exists. This indolent engorgement, or con- 
stitutional bubo, affects glands at a distance, and 
especially those of the back of the neck. I can 
very well recollect the importance Ricord used 
to attach, in his lectures, to this enlargement, and 
how, to use his own expression, post-cervical 
engorgement was a '^ most precious sign of con- 
stitutional involvement. ' ' The glands usually in- 
volved are those just on the side of the nucha 
below the occiput, those behind the posterior 
edge of the sterno-cleido mastoid, and the little 
gland just over the mastoid process. The first 
mentioned are, I think, most commonly impli- 
cated. When affected they vary in size, from a 
pea to an almond. In one of these women, on 
one side the gland is small, although hard ; on 
the other side it is nearly as large as an almond. 
On the neck of the second girl, both sides are 



equally, although moderately, enlarged. In the 
normal condition you cannot usually detect 
these glands, hence any induration or enlarge- 
ment is readily observed in disease, and becomes, 
as you may imagine, a useful point in diagnosis. 
The epitrochlear gland, just above the internal 
condyle of the humerus, is also not infrequently 
enlarged. 

Another secondary manifestation, and an early 
one, is falling out of the hair — alopecia. Here 
are two women in whom this condition is pres- 
ent. Each one has alopecia, each one a different 
form. The general account of this symptom, as 
they give it, is the same, namely, that in brushing 
their hair, and in washing, it comes out in 
greater or less quantities. Observe, if you please, 
the difference. These patients are both suffer- 
ing from general alopecia, involving the whole 
of the scalp ; the- hair comes out all over the 
scalp ; but it will grow again, after a time. In the 
first of these girls, the most recent case, the hair, 
on inspection, has not greatly altered in appear-^ 
ance ; it still retains its glossy, shining character, 
is pliable, and not brittle. Now see ; I take a 
few hairs by their extreme ends, and pull gently 5 
they all come out by the roots ; you can see the 
bulbs. I now take, in the same manner, some of 
the hairs of the second girl, and in like manner 
pull on them gently. Some few of them come 
out, but most of them break. To pull them out 
I must catch them lower down in their length. 
These hairs have lost their strength ; they are 
brittle, and break readily ; and so will those of 
the first woman, in all probability, after a while. 
In both of these patients the whole scalp is 
equally affected ; the condition is general alo- 
pecia. The hair will fall, but will again spring 
up, because the hair follicles and the papillge 
have not been destroyed. 

Next, turn your attention, for a moment, to the 
head of this third woman ; she has had a long 
and very severe attack of syphilis, which has 
reached the tertiary form, although she is now 
convalescent. Some time since deep ulcers 
formed here and there on the scalp ; these have 
closed up, cicatrized, and you can see the bald 
spots scattered over the scalp. This is local 
alopecia ; these bald spots will remain bald as 
long as she lives ; the hair follicles and the pa- 
pillge have been destroyed. In the first two 
cases of general alopecia the cause of the hair- 
fall has been the syphilitic dyscrasia, impairing 
or lowering the vitality of the blood. The same 
thing occurs in typhoid fever, in neuralgia, and 
possibly in malaria. An increased formation of 
the sebaceous matter will also produce, it is 
stated, the same result. But remember, that as 
long as the hair follicles remain, as in general 
alopecia, you may hope for regeneration and 
growth of the hair, to a greater or less extent. 
But when the loss of the hair is dependent on 
ulceration destructive of the hair follicles, the 
loss is irreparable. Occasionally the eyebrows 
and eyelashes are lost. I may here, in this con- 
nection, say a word as to the local treatment 
of general alopecia. It consists in keeping the 
scalp clean, by washing occasionally with tepid 
water containing a little borax, or a weak solution 
of ammonia ; gentle brushing, and the avoidance 
of fine combs. As a stimulant application, to be 



gb 



Hospital Reports, 



[Vol. xl. 



used at night, the following combination will be 
found useful: — 

^R. Glycerin, _ f.Jj_ 

Tincturse cantharidis, f. ^ ij 
Cologne water, f. ^ t. 

or the tincture of capsicum may be substituted 
for the cantharides. A favorite ointment, which 
has long been used for this jDurpose, is known 
as the pomade of Dupuytren. This contains 
a tincture of cantharides and acetate of lead, 
and is a well-known formula of the druggist's 
shop. 

In the next place, let me direct your attention 
to the examples of the early erujitions of syphilis, 
presented in kaleidoscoj^ic view, as it were, by 
the j)atients before you. If you turn to your 
books, 3''0u will find the syi3hilitic eruptions 
classified with great skill, and the dividing lines 
drawn with wonderful precision. In practice 
this is not altogether so, for you will find the 
varying types present in the same individual. 
Hence it is well for you to fix in mind the 
general characteristics of the eruption of syphi- 
lis. Indeed, one of the peculiarities of the 
eruption is its manifold character. See, here 
is a patient with a roseola on the trunk, and 
a scaly eruption on the lower extremities.' Here 
is another, with a roseola on the body, and a 
papular eruption on the face. Here is a woman 
with papular and eczematous spots. Here is 
another with mucous patches, and ecthymatous 
sores ; and I might bring many more such before 
you, but these are enough for my purpose at 
present. 

Let us examine these erujDtions more minutely. 
"The first thing that strikes you is the color. I 
hardly know how to define the color, for it is so 
changeable. In this girl, upon whom the roseola 
has just made its appearance, indeed, only three 
or four days ago, the spots are scattered on both 
arms, and are of a faint and very delicate pink. 
When I press upon them the color disappears, 
but immediately returns as I raise my finger. 
Notice how distinct these sj^ots are ; occasionally 
they touch and run together, but even when they 
do, the peripheral margins preserve their curves. 
The delicate color may perhaps be due to the 
fine texture of the skin, which in the unaffected 
parts is white and delicate. Sometimes spots 
such as these are evanescent. I have a woman 
in my wards, L. H., aged nineteen, with well 
marked engorgement of the post- cervical glands 
and a roseola upon the arms and legs. There is 
none upon the face, but it can be produced by wash- 
ing with cold water, and by friction with a towel. 
It then gradually fades away. The term ' ' copper 
color ' ' is often applied to syphilitic eruptions, and 
with a certain amount of truth. You see this hue in 
two or three of the patients ; notably in this man. 
Possibly this copj)er shade is more often met with 
in patients who have dark skins, in whom the erup- 
tion has been present for a i3rol6nged period. 
Whether you like the term or not, fix the color 
in your mind — a reddish brown, or brownish red, 
with a strong tinge of yellow ; the yellow often 
fading away into the natural color of the skin. 
In some of the patients the color is hardly cop- 
pery at all, or if it is, it is a very reddish copper. 
This is the shade which has often been spoken 
of as the color of raw ham. Here vou see it in 



a comparatively early eruption, and here in the 
smooth scar of a healed rupia up)on the leg. 
Varying as all these colors do, I think you will 
be able to form some idea of them, which I can- 
not give you in words. 

One peculiarity of these syphilitic eruptions I 
will ask you to note, and that is, that there i> 
seldom any itching. None of these patients have 
suffered in this respect, and I have often exam- 
ined individuals who scarcely knew of the exist- 
ence of these eruptions. I remember one gen- 
tleman especially, whose back was spotted witL 
a roseola from his shoulders to his hips, the 
result, as he afterward told me, of a trip down the 
Danube ; and 3- et he Avas sublimely ignorant of 
his acquisition. You will, I am sure, be struck, in 
looking at the group of patients before you, at 
the localities of these syphilitic eruptions. Most 
of them are situated upon the back, uj)on the 
front of the chest and belly, upon the legs and 
arms. The face, the hands, and the feet, are lest 
favored sites; and well it is so. I have seen 
patients covered with roseola from the heck to 
the instep, not a clean spot below the shirt collar 
upon which you could lay a silver dollar ; and 
yet they were walking about, attending to their 
daily avocations, and no one the wiser. As a 
rule, the face and hands escape ; but this is not 
always so. Here is a young man with a roseola 
a week old, and you see the front of hi^ face is 
unmistakably marked. 

As to the period at which roseola makes its ap- 
pearance, there is a good deal of variation. 
Generally it is developed about two months after 
the primary symptoms ; as a rule, the earlier its 
aj^pearance the sooner it fades away. A late 
roseola is apt to last. As a roseola disappears 
we often have desquamation of the cuticle, as you 
see in this case. The scales are then white, and 
fine, and are easily separated. There is one 
peculiarity in regard to syphilitic roseola you must 
bear in mind, and that is, that although it will 
yield readily to mercurial treatment, and fade 
away, it is apt to return. This may occur if the 
treatment be stopped too soon, or if the patient 
be imprudent in habits, or be much exposed. A 
return to the treatment will usually cause it again 
to disappear. 

Another of the early syphilitic eruptions pre- 
sents itself in the form of papules. I have here 
three well-marked instances. In two of them 
the pajDules have developed on the face, in one 
on the face and neck. In the men's ward there 
are several similar cases. In the two first women 
the papular eruption was coexistent with roseola 
on other portions of the body. I will ask you 
to notice the characteristics of these papules. In 
this case they are small, conical projections scat- 
tered over the face, especially numerous near the 
alae of the nose. As I turn the patient to the 
light I can distinguish on the tops of some of 
these papules little shining bodies ; these are 
vesicles filled with serum. On other papules the 
vesicles have burst, and have left fine glistening- 
scales, which are easily detached. It is some- 
what difficult to obtain a true history in this in- 
stance, but from what I can learn, this eruption 
has been an early symptom of the general infec- 
tion. Here iritis also is present, an affection of 
which I shall have occasion to say something to 



Feb. I, 1879.] 



Medical Societies. 



97 



you hereafter. In this other woman the papules 
are broader and flatter, appear, in fact, more solid, 
and are not tipped by vesicles. The papular form 
of secondary syphilitic eruption is, as a rule, 
chronic. It yields slowly to treatment, and is 
apt to recur. It soon loses its florid red or pink 
color, and assumes the darker hue of which I 
have spoken ; this, in its turn, gradually fading 
away. Occasionally, when chronic, papules are 
accompanied by itching. 

Mucous Patches. — Another of the early evi- 
dences of secondary syphilis is the mucous patch. 
This is found usually, as its name imports, upon 
the mucous surfaces of the body, near their out- 
lets, in the mouth, around the anus and vulva, 
and within the vagina. But the patch is also 
found on the skin proper at those points where 
folds of skin rub together, as between the but- 
tocks, low down in the folds of the groin. I 
liave seen them often between the toes, and below 
the breast, in the female. When the patch occurs 
on the skin near the mucous outlets it is usually 
rounded or curved, and elevated above the level 
•of the integument. The surface of the patch is 
rough, reddish, or grayish-red in color, and often 
covered with an exceedingly foul and fetid secre- 
tion, which is said, and I believe justly so, to be 
•contagious. Sometimes this singular growth is 
-developed on the site of a chancre. 

A favorite seat .of the patch is the mucous 
membranes of the mouth and lips. Here is just 
such an instance, occurring in a man who had 
primary symptoms about two months ago. I will 
ask him to ])ut out his tongue, and as he does so, j 
you notice the long, oval patch upon the side of j 
the tongue. It is grayish-white in color, not red- | 
•dish, is slightly elevated above the surrounding 
surface. It is annoying by its presence, rather 
than by any positive attendant pain. I will direct 
him to evert the upper lip, and you now perceive a 
long, flattened, shining surface, of apale pink; this 
also is a mucous patch, and I wish you to observe 
these two syphilitic manifestations very carefully. 
You may not infrequently see just such ]3atches 
as these in your practice, and you must know how 
to regard them. Remember, above all things, 
that they are infectious, and see to it that no 
spread of the disease occurs to third parties, by 
means of kisses, the use of the same towels, 
linen, drinking glasses, or other objects and 
utensils. 

The mucous patch, as I have said, is one of the 
'early secondary symptoms ; its average period of 
appearance being about seven or eight weeks 
after the primary infection. Its development 
is favored by personal uncleanliness, and in 
a hospital with such inmates as ours numerous 
examples of this lesion are always to be found, 
and I shall have occasion hereafter to bring 
before you illustrations of condylomata which 
are only aggregations of mucous elevated 
patches in the genital and anal regions. In leav- 
ing the subject, let me say a word or two in re- 
gard to the treatment of mucous patches ; of 
course, first of all, there must be the general con- 
stitutional treatment proper to the secondary 
syphilitic development. In the next place, local 
treatment must be employed ; the surfaces of the 
sores or vegetations should be destroyed by caus- 
tic ; the nitric acid I usually prefer. Perfect 



cleanliness should then be enforced ; the parts 
should be washed night and morning, or oftener, 
Avith permanganate of potash, or chlorinated soda 
solutions, and afterward they should be dusted 
with calomel and starch, in equal proportions. 
The attrition of opposite surfaces should be 
prevented by the insertion of a dry cloth. This 
is the treatment recommended by Dr. Bumstead, 
of New York, and I have usually found it to 
be efficacious. 

I have thus, gentlemen, brought before you this 
morning a few cases illustrative of the onset of 
syphilis. I have presented the patients as they 
came to my hand, and from them I think you 
may derive an idea of the Protean forms of this 
terrible disease. At the same time you will, I 
am sure, have seen that, differing, as the indi- 
vidual cases may do, there is still a general law of 
development. There is, in fact, a miarcli to the dis- 
ease, beginning with the infecting chancre, accom- 
panied by induration of the lymphatics and of 
the nearest lymphatic glands. These constitute 
primary syphilis. Then comes the secondary 
period of rncubation, then the syphilitic fever, then 
the post-cervical adenitis. These manifesta- 
tions are the skirmishers which precede the 
advance and deployment into line of battle of 
that fearful array, the secondary developments of 
constitutional syphilis. '^ ^' """ ^^" 



Medical Societies. 

colleoe of physicians, 
philadelphia. 

At the regular meeting, December 8th, 1878, 
Dr. William V. Keating read an article on 

An Endemic of Typhoid Fever, from Defective 
Drainage. 

The history was of a family in Spruce street, 
Philadelphia, four of whom were attacked by 
typhoid fever in rapid succession, two of the 
cases ending fatally. A competent plumber, who 
was called in to examine the plumbing, re- 
ported as follows: — 

"I made the examination and found there 
was no main trap in the drain pipe. There was 
a three-inch galvanized sheet-iron corrugated 
pipe leading from the French roof, between the 
outer front wall and the studding, and exposed 
in the cellar and connected with the terra- cotta 
drain near the cellar floor, every slip joint of 
which was pouring out its deadly contents of 
sewer gas, to be taken up by the large portable 
heater which was supplied with cold air from 
the cellar and distributed through the main 
building. I also found the waste pipe from the 
second and third story wash-basins trapped in 
the cellar, and smelling at the connection with 
the terra-cotta drain pipe near the floor. Here 
were two stories of waste pipe (with no traps 
under the basins) to help to vitiate the air of 
their respective apartments. I also found a 
four-inch rain conductor run down on the out- 
side of the back building, near the main build- 
ing, all joints of which poured out their quota 
of sewer gas to be carried into the house through 



98 



Medical Societies. 



[Vol. xl. 



the open windows, in pleasant weather. You I 
could not stand at any of the open windows in \ 
the rear portion of the house without being | 
sensible of the presence of sewer gas in the I 
surrounding atmosphere, caused by the exhala- ! 
tion of foul vapor from the rain conductors of \ 
the surrounding properties. After digging up ! 
the front of the cellar to put in a main trap, ! 
my workmen found the terra-cotta pipe jointed ' 
with common lime mortar. ' ' i 

In discussing the general bearings of this case, ! 
Dr. Keating remarked — | 

It is not my intention, and it would be a work | 
of supererogation on the present occasion, to go i 
into an elaborate discussion of the etiology of 
typhoid fever. You are aware that there are \ 
two prevalent theories. One teaches the spon- 
taneous, autochthonous, or de novo origin of the 
disease from a specific poison, which, after its 
passage through an individual, and further de- 
comj)osition, can be a source of contagion ; 
according to this view, the substances to be de- 
composed must be animal, consequently fecal, 
masses, and above all, human excrement. This 
is the vicAv advocated by Murchison. The other I 
theory, claimed by Budd, generally adopted by j 
the German school, and of which Liebermeister, 
in Ziemssen's Cyclopedia, is the able exponent, 
denies the spontaneous or de novo origin of the 
disease, and believes in the propagation of the 
so-called sjDecific germ, from the parent germ. 
It would be useless to restate the facts and observa- 
tions which support one or other of these views, 
and while the voluminous records of investiga- 
tion have not solved the question of etiology as 
a scientific problem, still, for practical purposes, 
we are fully able to stamp typhoid fever as 
an epidemic. The prevalent belief of this day j 
is that each zymotic disease is dependent upon a j 
specific poison or germ, so-called because it will, 
when introduced into the proper human soil, ! 
produce only the phenomena of the disease from ! 
which it originates. Thus, the scarlet fever germ , 
will only produce scarlet fever, but the type or I 
expression of the disease may depend upon the | 
condition of the individual, and to some extent | 
on the vitality of the poison. I 

It is generally admitted that the specific germ | 
of typhoid fever reaches the system by means of | 
the alimentary canal, and that its greatest 
activity is displayed when swallowed in drinking 
water or milk ; hence its most frequent occur- 
rence in the country, where cesspools connect 
with the drinking wells or dairy houses. Next 
in order it occurs where the air, and conse- 
quently all the ingesta, are saturated with the 
germs ; to the latter class my paper has special 
reference. Again, where the germs come in 
contact with the open air, as from upturned, 
saturated soil, or banks of low, polluted rivers, 
under hot August days and cool nights, with 
extreme evaporation of the poison during the 
day and condensation at night. 

The combinations found in sewer gas, where 
animal and vegetable decomposition have taken 
place, may, through some unknown cause, gen- 
erate de novo, or spontaneously, this poison. The 
specific properties which give it the form of 
scarlatina, measles, typhoid fever, or diphtheria, 
may be associated together in the same cesspool 



or sewer, and each one of these ajBfections will 
then appear in that individual most susceptible 
to its peculiar influence. Again, the immunity 
of certain persons exposed may depend upon 
previous mild attacks, and it has been proved 
that during an epidemic of any of these diseases 
few escape some symptoms of poisoning, how- 
ever slight ; but even this abortive form may 
protect the individual. Hence, it may be said 
that while the type or succession and severity of 
the symptoms can be regulated by the individual 
and ej)idemic influence, the specific character of 
the poison, whether a germ or gas, or whatever 
we may call it, depends for its elaboration or 
fabrication upon heat, moisture, animal and 
vegetable decomposition, apart from atmospheric 
air. The name, then of pythogenic fever, sub- 
stituted by Murchison, does not hold good for 
typhoid fever, because it withholds the specific 
character of the disease ; it can only be efficient j 
in septicemia or foul-air poisoning, with its 
variety of irregular symptoms, indeiDcndent of 
specific origin. 

Although Dr. Budd, I believe, maintains the: 
contagiousness of typhoid fever, yet hospital ex- 
periences, from which we can derive the most 
satisfactory and conclusive evidence on the sub- 
ject, give but little support to this view; and 
while it is of universal experience that hospital 
attendants are very liable to be attacked in nurs- 
ing cases of typhus fever, it is also generally ad- 
mitted, on the other hand, that medical attend- 
ants upon typhoid or enteric fever rarety contract 
the disease from the sick under their care. Thus^ 
during twenty-three years, from 1848 to 1870, 
while 5988 cases of enteric fever were admitted 
into the London Fever Hospital, only 17 resi- 
dents in the hospital contracted the disease, and 
most of these had no personal communication 
with the sick. Of the 17 cases, 9 occurred in 
nurses, and 12 of the 17 occurred subsequently 
to 1864, when various extensions of the hospital 
buildings led to a serious derangement of the 
drainage. But the most remarkable fact is what 
follows. Since 1861 it has been the practice in 
the same hospital to classify the patients, thus: 
The typhus, relapsing, and scarlatina patients 
have been kept in distinct wards, whereas the 
patients suffering from enteric fever have been 
kept in the same wards with many other patients 
sent to the hospital, but who have not been the 
subject of any form of contagious fever. The 
two classes have remained together both during 
the acute stages of their maladies and in their 
convalescence, and in most instances for several 
weeks. The same night chairs have been used 
by both classes, and the employment of disin- 
fectants has been exceptional. Here is the re- 
sult. During nine years 3555 patients with 
enteric fever have been treated along with 5144 
patients not suffering from any specific fever. 
Not one of the latter has contracted enteric fever. 
In examining the statistics of St. Joseph's Hos- 
I)ital I find that while 272 cases have been treated 
there in ten years, in the same wards with other 
cases, the patients using the same night chairs, 
and the stools not being disinfected, there is not 
a single record of the disease having originated 
in the house.* My friend Dr. Guiteras has ex- 
*Se3 Murchison on Continued Fevers. 



Feb. I, 1879.] 



Medical Societies. 



99 



amined the records of the Philadelphia Hospital, 
and can only find that within the last ten years 
two attendants have been attacked with typhoid 
fever — one the resident physician, who may have 
contracted the disease outside, and a nurse, 
whose case was doubtful. All evidence, there- 
fore, is, I think, in favor of the view that the 
fresh evacuations are harmless, and that the 
poison is developed during their putrefaction. 

While admitting that enteric or typhoid fever 
can originate from the specific poison generated 
in decomposition of the evacuation, it seems to 
me that it must also be admitted that the disease 
may have a spontaneous or de novo origin. The 
individual experience of most of those here pres- 
ent, combined with the voluminous published 
records of the autocthonous origin of disease, in 
its sudden outbreaks in isolated places, and 
under circumstances where there has not previ- 
ously existed any trace of its continuous origin, 
are sufficient proofs in themselves to justify the 
assumption that where typhoid fever breaks out 
in a private dwelling or hospital, without the 
previous introduction of a case of the same dis- 
ease, there is something radically defective in the 
sanitary arrangements, and that either the air or 
water is polluted with decomposing excrement. 
Not to trespass upon your time, I will merely 
recall the celebrated Clapham school cases cited 
by Murchison, where twenty boys out of twenty- 
two were seized within three hours with fever, 
vomiting and purging, and excessive prostration, 
and the only cause which could be discovered 
originated from a choked-up drain, which had 
been opened, cleaned out, and its contents spread 
over the garden adjoining the boys' playground, 
two days before. The morbid appearance in the 
two fatal cases were those of typhoid fever. It 
may be objected in regard to these cases, as well 
as in regard to those reported by me to-night, 
that the course of the disease, especially in its 
incubation, was more rapid than that which usu- 
ally characterizes typhoid fever, but this may be 
accounted for by the intensity of the poison. 

In Miss F.'s case, as it had been a month since 
she left Renovo, on the 29th of August, it was 
not probable that the period of incubation should 
have lasted until the 9th of October. I beg leave 
also to cite a more striking instance in our own 
country : I refer to the outbreak of typhoid fever 
at Bar Harbor, Mount Desert, in August, 1873, 
so accurately and graphically described by Dr. 
W. J. Morton in the Boston Medical and Surgi- 
cal Journal for October, 1873. In the little town 
of Bar Harbor, on Frenchman's Bay, situated on 
a beautiful slope of the island of Mount Desert, 
in an atmosphere in which,, from its purity and 
exhilaration, one experiences ajoyousness of ex- 
istence, and where all '' save the spirit of man is 
divine," there broke out, at the Bay View House, 
during the month of August, 1873, an endemic 
of thirteen cases of typhoid fever, all caused from 
an overflowing cesspool, maintained within ten 
feet of the verandah of the hotel, in combination 
with the drain in the same field full of putrefying 
material collected from the kitchen garbage of 
the Harbor House. Dr. Morton exhibits a dia- 
gram of the cesspool, and its location as regards 
the hotel, and proves conclusively that, in a crowd- 
ed house, a case of typhoid fever was associated 



with every room except one, on the side of the 
house exposed to the drain emanations, and that 
the inmates of the room which, owing to its pe- 
culiar construction, formed a pocket in which 
ventilation was a remote possibility, were the 
most seriously afi'ected. During my sojourn on 
the island, in the summer of 1874, I visited the 
site of this dreadful disaster, which nearly blighted 
the prospects of this beautiful spot as a place of 
summer resort. Upon careful inquiry from the 
most reliable lay sources, the town having always 
been so healthy as not to require any resident 
physician, I could not discover that, within the 
memory of any of its inhabitants or any of its 
constant visitors, a case of typhoid fever had 
ever existed there before the outbreak just de- 
scribed. 

Among the innumerable records of similar in- 
stances, I have cited these cases as a proof of 
the spontaneous or de novo origin of typhoid 
fever, believing that any one incontestable proof 
of its autochthonous origin would be sufficient to 
give reason for the faith that is within me, of the 
occurrence of the spontaneous outbreak of the 
disease under a combination of the same circum- 
stances. 

Another point which it seems to me is often 
overlooked in the discussion of this subject, and 
which is of paramount importance in the pre- 
vention of the disease : We admit the theory of 
a living germ of specific poison, and forget that 
there is another factor in the case, of equal 
imi3ortance. I refer to the receptivity of the 
soil or blood into which this germ or poison is 
introduced. In a normal condition, we admit 
the autonomy of the individual, but pathologi- 
cally all stress is laid upon the potency of the 
germ, and very little reference to the varying 
constitutions of the recipients. Yet, when we 
come to analyze the fact, admitting either of the 
above theories, both of which unite in the belief 
of a specific poison or germ, we have to admit that 
it is due to the susceptibility of the soil or blood, 
to select the specific germ from the variety 
collected in the emanations from decomposing 
organic matter, which can fructify and repro- 
duce its characteristic phenomena. Whence 
this peculiar affinity of the soil or blood for the 
specific germ? We must all acknowledge that 
the varying virulence in smallpox or scarlet 
fever is not always due to the quantity or quality 
of the poison, but to the constitution or re- 
ceptivity of the blood of the individual. 

In the case of Miss F., there were no abdomi- 
nal symptoms throughout the disease ; not a 
symptom of any intestinal disturbance. The 
condition of the tongue, very red and flabby, 
pointed, throughout the whole case, more to a 
general blood disease than to the effect of a 
specific poison. Still, Miss F. had been sub- 
jected to the same influences as the others. 

In the year 1850 I had occasion to visit a 
family in Race street, in which two of the 
children were attacked with measles, one with 
scarlet fever, and a fourth one with a hybrid of 
measles and scarlet fever combined, a phenome- 
non which the late Professor Meigs observed 
with me. All the inmates of the house were 
affected more or less, and one of the servants 
was attacked with typhoid fever. At the sug- 



lOO 



Medical Societies. 



[Vol. xl. 



gestion of Professor Meigs, I examined tlie 
house carefully, and finally discovered that the 
cesspool of the neighboring house was leaking 
into the cellar of the back building. The chil- 
dren slept in the second story of the back build- 
ing, the servant who had typhoid fever slept in a 
sort of out-house, but on the ground floor, in 
close proximity to the obnoxious exhalations 
from the infected cellar. 

In 1863 I attended a family in East Delancy 
Place, where there prevailed, within two weeks, 
scarlet fever, measles, diphtheria, and a case of 
typhoid ambulatorius. An examination of the 
premises revealed in the cellar an old cesspool, 
covered up without having its contents removed. 
The cement or mortar had cracked, and foul 
exhalations were oozing out. I could cite one 
house in Thirteenth street, where the whole 
family of a gentleman who had changed his 
residence from the country, suffered within a 
month from attacks of measles, scarlet fever 
and diphtheria. Another, in Walnut street, above 
Twenty-first street, where, after the family had 
moved in, I was in attendance for two months 
for cases of scarlet fever, diphtheria and typhoid 
fever. In these last instances, ujion examina- 
tion, it was discovered that, though the houses 
were otherwise in a perfect sanitar}' condition, 
no trap had been placed at the exit of the terra- 
cotta drain in the cellar; a defect in drainage 
which I am afraid, even in the best and most 
expensively constructed houses in our city, is 
more common than most of us are aware. Even 
in the houses cited, there were inmates whose 
powers of resistance enabled them to throw off 
by the different emunctories the results of these 
poisonous agents. Another class become more 
or less gradually acclimated, others brokenly 
live on, themselves and their medical attendants 
ignoring the cause of their continued malaise, 
dragging out a miserable existence, subjected 
to the same influence as their more weakly 
constituted brethren in whom a violent ex- 
plosion of the disease may have produced a 
fatal result. How many cases of so-called 
abortive typhoid fever we have all of us seen, 
in which the general symptoms almost with 
Certainty pointed to the character of the disease, 
but in which the absence of the more pathog- 
nomonic signs made us hesitate about our diag- 
nosis. In all these cases the essential cause 
is the poisoning by emanations from decom- 
posing organic matter, in which originates, ac- 
cording to the modern theory, the germs of the 
various types of diseases. 

There is then an affinity and selection on the part ' 
of the soil for the s]3ecific germ. One soil re- ' 
ceives and fructifies the scarlatina germ ; an- 
other, under the same circumstances, the typhoid 
fever germ 5 a third, the diphtheria germ ; but 
will any one attribute this to mere accident? 
Can there be here, in accordance with our mod- 
ern view of genesis, a specific ovum or cell in 
the blood of the individual which is vivified by 
its congener cell in the sewer gas ? Account as 
we may for the development of the specific germ, 
there must be receptivity in the soil which re- 
ceives, and it is perhaps destined for future 
experiments to determine what the peculiar 
element, either present or wanting, in the blood, 



which endows it with this receptivity or suscepti- 
bility. Quinia, discovered not through any 
observation as regards the character of the ma- 
laria spore, arms us with Achillean shield in the 
presence of vegetable decomposition, and of its 
resultants as seen in the Protean forms of mala- 
ria. The same drug is becoming our mainstaT 
in the treatment of the blood poisoning of septi- 
caemia. May I not suggest that, among the jDre- 
ventives, some combination of quinia with 
carbolic acid or other antiseptic agent, dissolved 
in an innocuous fluid, like milk, may yet be 
transfused into our circulation, and antagonize 
that specificity or receptivity which seems to be 
as essential a factor in the poisoning as the germ 
itself. 

Dr. William G. Porter reported a case of rapid. 

Post-Mortem Emphysema. 

The subject, a man of fifty-eight, temperate 
and previously healthy, was seized with nausea, 
vomiting and intense epigastric pain, and died 
in a few days. The following then occurred : — 

At 8 o'clock in the morning the undertaker 
called on me and informed me that the body had 
swollen so enormously that he was afraid it would 
burst. About 9 a. m., accompanied by Dr. 
Morris Longstreth, I visited the house, and found 
that the body had swollen so much as to raise 
the lid of the ice-box several inches, although 
the corpse had been freely covered with ice. 
Permission was readily obtained to make a post- 
mortem examination, when, on removing the ice. 
the whole body was found to be intensely jaun- 
diced and enormously swollen. The features 
were so much distended as to be unrecognizable, 
and the face was covered with clotted blood, 
which had been forced out from the bloated 
mouth and nostrils. 

On making the usual post-mortem incision in 
the median line of the body, air, without appre- 
ciable odor, escaped from the cellular tissue ; 
the tissues receded from the knife as if they had 
been stretched to the utmost ; a large quantity 
of air, also without odor, escaped from the joeri- 
toneal cavity ; and the over- distended bowels 
ballooned through the incision over the abdo- 
men. The genitalia were enormoush'' distended 
with air. There was no evidence of peritonitis. 

The liver was of normal size and natural color, 
but exceedingly friable, iDcrmitting the finger to 
be easily thrust in all directions through its sub- 
stance ; on section Avith a clean knife, blood and 
globules of oil escaped. The gall bladder was 
full of normal bile ; there were no gall stones, 
and there was no distention of the duct. The 
liver was emphysematous, and floated high on 
water. The spleen was of normal size, also em- 
physematous and friable, and presented the same 
appearances on section as the liver. The bowels 
were very considerably distended with air, and 
on being punctured previous to sewing up the 
body the gas which escaped was almost if not 
entirely inodorous. The kidneys were easily re- 
moved without the aid of the knife, lea"\dng the 
capsules in situ; they were also emphysematous, 
and presented the same appearances on section as 
the liver. The stomach was also distended with 
air, and contained a considerable quantity of 
broken-down and disorganized blood. The heart 



Feb. I, 1879.] 



Periscope, 



lot- 



was empty, containing neither blood nor clots of 
any description ; its tissue was softened, empliy- 
sematons, floating high on water, and presenting 
the same appearances on section as the liver. 



On puncturing the distended lips, eyelids, and 
scrotum, large quantities of air, entirely inodor- 
ous, escaped, and the distended parts collapsed,- 



Editorial Department, 



Periscope. 



Eemedies in Headache. 

Dr. W. H. Day makes the following remarks 
on some remedies for headache {British Medical 
Journal) : — 

Croton- chloral has been recommended by Dr. 
Liebreich, of Berlin, as possessing a special action 
on the sensory branches of the fifth nerve. It 
is of most benefit in facial neuralgia, relieving 
pain and producing sleep. I have known it to* 
prove very serviceable in some cases of nervous 
headache in which the disorder has chiefly oc- 
cupied one temple, the occiput and neck, or one 
parietal bone ; and in other cases not only to 
utterly fail, but to induce sickness and nausea, 
if they did not previously exist. I generally 
give ten grains for a dose, in plain water, though 
it has been recommended to dissolve the remedy 
in a few drops of glycerine and then add the 
required quantity of cinnamon water, which, 
to some extent, disguises the bitter, nauseous 
taste. On this account, it may be given in the 
form of a pill, beginning with two grains and 
increasing the dose according to the urgency of 
the symptoms. 

Hj^drate of chloral is a remedy which has 
become one of the most frequently chosen of 
therapeutic agents, from its hj^^notic effects. 
In large doses it is narcotic, and in very large 
doses it is said to produce anaesthesia. In 
nervous and spasmodic diseases, as puerperal 
convulsions, trismus nascentium, and the sleep- 
lessness of chorea, we all recognize its value. 
In headaches, whether of the nervous or vas- 
cular type, when the pain is wearing out the 
patient and sleep cannot be obtained, chloral 
is of undoubted value. Chloral is a remedy re- 
quiring extreme caution in its administration 
whenever headache has recurred so often as to 
exhaust the patient's nerve force. Where the 
pulse has become small and weak, through con- 
stitutional debility or failure of the heart's 
action,_ a full dose may be followed by syncope. 
Incautiously administered, it may reduce the 
requency of the respiration and annihilate the 
pulse. It lessens blood-pressure by its action 
on the vaso-motor system, and also by depress- 
ing the heart's action; hence it requires caution 
in cases where the patient, although severely 
suffering, is exhausted. In some cases, after 
its administration, I have observed such pro- 
found sleep and quiet and shallow respiration 



as to make me cautious in employing it where 
the circulation is feeble. 

Chloral has a decided effect upon the vascular 
system, and if the pulse be firm or hard, the 
face flushed, or the excitement considerable, 
it relaxes the muscular walls of the arteries 
and reduces blood-pressure. It has been re- 
commended not to employ a larger initial dose 
than ten grains; but I have never witnessed 
any effects of an overdose from twice the quan- 
tity. Very alarming symptoms have followed 
doses of forty and even thirty grains, so that 
its use requires caution, ,if the nerve power be 
much reduced. 

G-elsemium is something useful in neuralgic 
headache and the neuralgia arising from decayed 
teeth. The powder and the tincture are the 
two forms for administration. The dose of the 
former is from one to two grains, and of the 
latter from ten to twenty minims. It is a pow- 
erful remedy, and, as many fatal cases are re- 
corded from an overdose, its use requires caution. 
My experience of it is very limited, from having 
many more remedies at my command with 
which I am better acquainted. In one case I 
gave a grain of the powder in a pill every 
night, for sleeplessness caused by neuralgic head- 
ache, and it exercised a most beneficial effect. 

Phosphorus is one of the most important 
agents we possess in nervous exhaustion, and 
its efficacy is undoubted when administered in 
an unoxidized state, capable of being readily 
assimilated. No remedy requires more care 
in prescribing than this; for, while in small 
doses it is a gentle stimulant and tonic, in large 
doses it depresses the heart's action, like chloral, 
and is not free from danger. 



How to Give Electric Baths. 

A correspondent of an English contemporary 
writes: — 

There are several ways of making or giving 
the electric or galvanic bath. One is, having 
a wooden bath lined with copper, and haying 
a crossbar of wood and copper for the patient 
to hold as he lies in the water. One of the 
cords from the battery is attached to either the 
ijar or the copper part of the bath, which be- 
comes the positive pole ; the negative is placed 
in the water. The water should be from 85° 
to 95°. Another method, which is much easier 
of application, is used by mc constantly. It 
is an ordinary long dressing-room bath, two 
parts filled with water, 90°, so that the patient 



I02 



Reviews and Book Notices, 



[Vol. xl. 



•can lie down comforteibly ; the water is then 
charged by placing two plates of copper (size 
12 by 6) into the water ; the plates are attached 
to the cords from a Meyer and Meltzer con- 
tinuous current battery. The plates must not be 
allowed to touch the person, for a sharp burn- 
ing is at once felt, and they will almost jump 
out of the bath, from the sudden pain. I have 
seen a patient after twenty minutes in a bath 
of this kind look just like a boiled lobster, 
the skin being very red, and giving a tingling 
sensation for some little time. The diseases 
for which I am in the habit of using it chiefly 
are, plumbism, lead colic and dropped wrist, 
rheumatism ( subacute and chronic ), nervous 
debility, amenorrhoea, want of development of 
the uterine organs, infantile paralysis, paralysis 
agitans, progressive locomotor ataxy, and im- 
potency; and, considering that nearly all these 
diseases are of a slow or chronic type, this 
kind of treatment has been most successful. 



Poisoning from Sweet Spirits of Nitre. 

This widely used remedy is unsafe in an over- 
dose. The following case of poisoning is reported 
by Dr. T. W. Hill, in the Lancet .— 

I was sent for on Thursday, September 26th, 
1878, to see a male child, aged two years and 
eleven months, who had climbed up on a chair 
and taken from off the mantle-piece a stoppered 
bottle containing between three and four ounces 
of sweet spirits of nitre, and drank the contents, 
during the absence of the attendant. On my 
arrival, at 1 p.m., I found him in a complete state 
of collapse, cold, almost pulseless, insensible, 
both pupils fixed and widel}^ dilated, breathing 
hardly perceptible. Before seeing him he had 
vomited freely, the contents of the stomach being 
undigested food (no blood), with a smell of spirit ; 
the bowels had been well open. I had him 
placed in bed between warm blankets, and hot- 
water bottles applied to the feet and armpits. 
After an hour and a half the temperature of the 
body began to grow warmer, and at three o'clock 
seemed of a burning heat f slight perspiration 
apparent, pulse slightly improved ; strong smell 
of spirit from the breath. At 6 the vomiting 
and purging recurred; at 10.30 the breathing 
became stertorous, and he died at half-past 11, 
just twelve hours after he had taken the fatal 
dose, no convulsions having occurred. 

Necropsy^ three days and a half after death. — 
Body measured thirty- six inches, well nourished. 
No external signs of injury. On opening the 
abdomen, a strong alcoholic odor was emitted. 
The stomach contained food, chiefly bread, in a 
state of semi-digestion ; the mucous coat was 
highly inflamed and red near the pyloric end, on 
the anterior surface of the posterior border, 
and in one spot very much attenuated. The 
duodenal end of the small intestines red and in- 
flamed and bile-stained ; the remainder of intes- 
tines healthy. Kidneys slightly congested. The 
other organs healthy. On removing the skull- 
cap, I found the membranes of the brain highly 
congested, containing a large quantity of dark- 
colored blood. Brain soft, pulpy, and quite j 
wet ; vessels congested ; no trace of fluid in the i 
ventricles. ! 



Reviews and Book Notices. 

NOTES ON CURRENT MEDICAL 
LITERATURE. 

A pamphlet of 16 pp., by C. G. & J. U. 

Lloyd, of Cincinnati, gives a very satisfactory 
account of the Berberidacese, their botanical de- 
scription, commercial history, medical properties 
and pharmaceutical relations. Those interested 
in our indigenous medical botany should pro- 
cure it. 

Dr. M. Landesberg, of this city, has issued 

a paper of sixty odd pages, containing the sta- 
tistics of 123 operations for cataract. The notes 
have been carefully taken, and will no doubt be 
appreciated by ophthalmalogists. 

BOOK NOTICES. 

Cyclopedia of the Practice of Medicine. Edited by 

H. Von Ziemssen. Vol. xiii. Diseases of the 
Spinal Cord and Medulla Oblongata, by Prof. 
W. H. Erb. Vol.xvii, General Anomalies of 
Nutrition and Poisons, by Professors H. Immer- 
man, R. Boehm, B. Naunyn, and H. Von Boeck. 
New York, Wm. Wood & Co., 1878. 
In the thirteenth volume Prof. Erb begins his 
discussion of diseases of the spinal cord, with 
general considerations on their symptomatology 
and etiology. In the latter he assigns the first 
place among acquired predisposing causes to. 
sexual excess. While he acknowledges that at 
times the influence of this factor has been over- 
estimated, he believes that at present the tendency 
is to underrate its dangers. With Sir James Paget, 
however, Prof. Erb does not consider masturba- 
tion any more pernicious than natural coitus, an 
opinion in which we are fully convinced both these 
eminent authorities are in error. 

Following this, the diseases are divided into 
those of the membranes and those of the sub- 
stance of the cord. ' ' Spinal irritation ' ' is justly_ 
recognized as a distinct and real disease. Mye- 
litis is subjected to an extended inquiry, and an 
effort made to clear up the obscurity which hangs 
over the varieties of this multiform complaint. 
Tabes dorsalis is the old name retained for a 
group of symptoms which have been variously 
divided of late years. Prof. Erb states that he 
has extensively studied Westplial's diagnostic dis- 



Feb. I, 1879.] Reviews and Book Notices. 



103 



covery of " Tendon Reflex,'" and reposes great 
confidence in it. 

In the other vohTme mentioned at the head of 
this article, Prof. Immermann discusses heemo- 
philia, scurvy, and the morbus maculosus. He 
recognizes the wide-spread existence of land 
scur^'y seen in recent j^ears ; and although he 
speaks of the "chaos of professional opinion" on 
this malady, he judiciously recognizes the con- 
dition as an individual disease. What he calls 
the morbus maculosus of Werlhof is better known 
as purpura hemorrhagica, and it would have been 
better to have retained this latter title. 

Most of the volume is occupied with poisons. 
Boehni treats poisoning by mettalloids, mineral 
and vegetable acids, alkalies, anaesthetics and 
tainted food ; Naunyn discusses poisoning by the 
heavy metals and their salts ; and Von Bceck the 
vegetable poisons. These are all discussed with 
considerable fullness, and a full line of authori- 
ties quoted on the S3^mptoms, pathology, etc., of 
the various attacks. We note, however, that 
under mushroom poisoning nothing is said of the 
antidotal power of daturine, and the antagonism 
of poisons might advantageously have been more 
fully brought out in several cases. 

The typographical execution of the work is, as 
usual, entirely satisfactory, and the careful index- 
ing and j)roof reading it has receiA^ed are points 
of value to every reader. 

Half- Yearly Compendium of Medical Science. Part 
xxiii, January 1879, pp. 300. D. Gr. Brinton, 
115 S. Seventh street. Price 12.50 per year. 

The January number of the Half- Yearly Com- 
pendium contains articles on 213 subjects, and 
from 215 writers who have contributed important 
articles to periodical medical literature within 
the last six months of 1878. Of these 04 are 
American and 121 foreign. Sometimes they are 
given in abstract, sometimes in the words of the 
original. The whole range of medical literature 
has been investigated, the woi-k being divided 
into seven sections. 

With such a comprehensive plan, and carried 
out in such a thorough manner, little which-is at 
once new and worth knowing has escaped the 
eyes of the compilers. 

The editor announces that the next number, 
that for July, will complete the second series, 
and that it will include indexes to each of the 
seven, departments, which, as they are separately 
paged, can then be taken apart and bound in 
independent volumes. 

The publisher offers the Compendium to sub- 
scribers to the Reporter at $2.00 per j^ear, and 



as its field and its contents are wholly separate 
from that of the weekly, the combination makes 
one of great value to practitioners. 

The attention which is given to American au- 
thors in this publication gives it a distinctive value 
which none other of the class possesses. 
Physiology; Preliminary Course Lectures. By James 
T. Whittaker, m.a. m.d.. Professor of Physi- 
ology in the Medical College of Ohio. Cincin- 
nati, Robert Clark & Co.; pp. 288. Price 
11.75. 

In a dozen lectures, which in all make up but a 
small-sized volume of less than 300 pages, the 
writer gives a brief sketch of the history of physi- 
ology, the doctrines of the conservation of force, 
the origin and evolution of life, protoplasm, and 
the properties of bone, muscle, nerve and blood. 
Necessarily, in such a survey, much must be stated 
incompletely, much must be taken for granted, 
the connection of many associated researches left 
vague and ill-defined. Yet, as the author informs %■ 
us in the title ^nd preface that these lectures are 
preliminary only, and adapted to ' ' the reach and 
comprehension of the first course student," it 
would be unfair to condemn. In fact, as jDopular 
presentations of physiological themes, the lectures 
are good, in some parts uncommonly good. The 
statements are lucid and the style entertaining. 

Nevertheless, we confess to a doubt as to 
whether it was worth while to put in such a per- 
manent form as- a book such confessedly element- 
ary instructions. We must acknowledge that, 
having long been familiar with the author" s ability 
in certain fields of research, we were disappointed 
that he did not give us his best rather than his 
easiest. He can do so much better work than is 
here exhibited, that the present example does not 
do him justice. 

An Introduction to Morbid Anatomy. By T. Henry 
Green, m.d., London. Third American from 
the fourth Enlarged English Edition. With 
132 illustrations. Philadelphia, Henry C. Lea, 
1878, pp. 329. 

The treatise of Dr. Green is compact, clearly 
expressed, up to the times, and popular as a text 
book, both in England and America. The cuts 
are sufficiently numerous, and usually well made. 
In the present edition such new matter has 
been added as was necessary to embrace the later 
results in pathological research. The general 
plan of the work has not been altered, and the 
additions do not add inconveniently to its bulk. 
No doubt it will continue to enjoy the favor it has 
received at the hands of the profession. 



I04 



Editorial, 



[Vol. xl. 



Medical and Surgical Reporter, 

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iBsixedL every Saturday. 



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Philadelphia, Pa. 

LATE DISCOVERIES RE&ARDING THE NATURE 
OF CONTAGION. 

Recent researches into the intimate nature of 
contagion have led to positive results in that 
branch which cannot but have great influence 
on the medicine of the future. 

The most definite of these results have been 
obtained in the study of diseases of the lower 
animals. A little more than two years ago Pro- 
fessor Koch published in the Beitrdge zur Biolo- 
gie und Pjianzenkunde (1876) a study of the 
contagious principle of anthrax in cattle. ^This 
disease is very common in the bovine species and 
among sheep. It is less common in horses and 
swine. So fatal is it in some districts, that it 
forms a serious impediment to the successful 
prosecution of stock raising. Thus in the Scotch 
Highlands it is stated, on good authority, that in 
some years fully fifty per cent, of the total mor- 
tality among the flocks is due to the disease 
known as ' 'braxy, ' ' which is but a form of anthrax. 
In France, under the name "charbon," and in 
this country as '' bloody murrain" and ''black 



quarter," anthrax is familiar to most farmers as 
a much dreaded and most fatal disease. 

The histological investigations of Dr. Koch led 
him to the discovery, in the blood of anthracose 
patients, of a vegetable organism of the genus 
Bacillus, to which he applied the name Bacillus 
anthracis. As is well known to microscopists, 
the Bacillus is, as its name denotes, a slender, 
rod-like filament, straight or disposed in angles, 
sometimes in a zigzag form. The most familiar 
representative of the genus is the Bacillus suhtilis, 
which can generally be discovered in an ordinary 
infusion of hay, and is often found in drinking 
water, developed probably from the grass which 
has fallen into the parent streams. 

Last spring Dr. Klein, of London, supple- 
mented the work of Prof. Koch by a series of 
most carefully carried out researches on the dis- 
ease of swine which is known in Ireland as 
"red soldier," and which in this country is only 
too familiar as ''the blue disease," as it is one 
of those often grouped under the meaningless 
name of "hog cholera." He found it wholly 
dissimilar from the anthracose diseases, in devel- 
opment and pathology, though resembling them 
in symptomatology. The blood did not reveal 
the Bacillus anthracis ', but a microscopic inves- 
tigation of the serous fluid found after death in 
the pleural and peritoneal cavities, as well as 
that contained in the serous membranes, disclosed 
innumerable individuals of another Bacillus, in 
all respects, as far as noted, resembling the Ba- 
cillus suhtilis. The question arose, was this the 
contagium vivum of the disease? 

To answer this momentous question Dr. Klein 
took an exceedingly small quantity of the dis^ 
eased serum and placed it in a drop or two of 
aqueous humor from the eye of a rabbit, and 
closing it hermetically incubated it in a sand bath 
for twenty-four hours ; at the expiration of this 
time, he took a like minute quantity of this pro- 
duct, and placing it in some more aqueous humor, 
repeated the process; and so on for eight 
times ; so that unless there was actual and rapid 
reproduction of the supposed contagium, its dilu- 
tion would have been so great that as a mere ' 



Feb. I, 1879.] 



Notes and Comments. 



105 



poison it could have absolutely no effect. With 
this last dilution he inoculated several healthy 
pigs who had not been exposed to any other form 
of the contagion. The experiment was crucial 
and the result indisputably Every one pf these 
pigs fell sick and died, exhibiting in the period 
of latency the sj'-mptoms and the pathological ap- 
pearances, every one of the characteristics of the 
disease in question, to which Dr. Klein has given 
the name of ''contagious pneumo-enteritis." 
Certainly no experiments could be imagined more 
satisfactory and convincing than these. 

Still more recently Professor Klebs has tried 
this method of the cultivation of coritagium out- 
side the body, with the syphilitic poison, and with 
like brilliant results. He found that by removing 
a primary, indurated Hunterian chancre, and 
submitting it with certain precautions to a micro- 
scopic investigation, moving vegetable forms were 
discoverable, which, in their earlier stages were 
also rod-like, or similar to Bacilli^ and later ar- 
ranged themselves into globular or ovoidal masses, 
by numbers of simpler forms weaving themselves, 
as it were, into a ball. These forms he cultivated 
in a manner analogous to that described above, 
through several generations, until it was abso- 
lutely certain that no other product of the origi- 
nal chancre was present in the solution, beyond 
these self- multiplying vegetable forms. . 

To avoid a further possibility of error which 
would be presentif the inoculation were performed 
on a member of the human species, he chose as 
his subjects monkeys, both male and female. 
The result was as striking as in Dr. Klein's ex- 
periments. These animals, after the usual period 
of latency, to wit, six weeks, were attacked with 
unmistakable secondary syphilis, followed by the 
usual tertiary forms of osseous degeneration, etc. 
Very careful autopsies of the animals revealed 
nearly all the syphilitic changes in the hard and 
soft parts which the disease produces when un- 
checked in the human race. The well defined 
and easily recognizable organisms which these 
experiments prove to be the contagium vivum 
of syphilis, Prof. Klebs calls by the provisional 
name helico-monads. 



I All must agree that these discoveries, which thus 
define so clearly the contagious principles of three 
most terrible scourges of three different species 
of animals, are among the most momentous of 
this decade. The ground thus cleared, with a 
positive knowledge of what it is we have to fight 
against, the next step — the grand one, of the dis- 
covery of an agent which will render the animal 
economy an inapt soil for the growth of these 
vegetable organisms — is neither an impossible one, 
nor, we have faith to believe, is it very remote. 



Notes and Comments. 

Bills Presented, and a Few Words About Them. 

Inclosed in this number of the Reporter we 
forward bills for the current year, to all our sub- 
scribers from whom we have not heard ; and we 
respectfully ask that in all instances those who 
receive them will give them early attention, by 
remitting us the amount in the usual way. 

Should, in any case, the subscriber think the bill 
is incorrect, it will give us the greatest pleasure 
to forward a detailed statement and make any 
corrections which the facts require. We try to 
exercise the utmost care in these matters, but the 
most accurate are occasionally at fault. 

We are well aware that in some instances pay- 
ments can be made more conveniently later in 
the season. In such cases, we urgently request 
subscribers to write us to that effect, stating in 
what month they will respond, so that we can 
make a note of it, and not annoy them with in- 
quiries. A few minutes of time and the use of a 
postal card are all that are needed in any case to 
prevent the unpleasant emotions which attend 
not only the receipt but also the presentation of 
a "dun." 



Eesections of tflie Knee. 
Dr. Servais, of Antwerp, in a monograph re- 
cently published, entitled "Conservative Surgery," 
a notice of which is translated by Dr. Prasegler, 
of this city, gives a new method of procedure in re- 
sections of the knee, and states the results of ten 
consecutive operations, of which three were com- 
plete resections of the knee. The patients are in 
good health, and can walk from morning until 
night. Of two cases of resection of the superior 
extremity of the femur, the one patient has a 
shortening of 14 c, the other of 8 c. They both 
walk easily without support. Of thrfee cases of 



io6 



Notes and Comments. 



[Vol. xl. 



complete resectiou of the elbow, the patients 
enjoy all the functions of the removed articula- 
tion ; one case of resection of the scaphoid and 
the three cuneiforms ; amputation upon malle- 
oli and cured. In one case of resection of the 
inferior extremity of the fibula, the patient walks 
well and health excellent. These patients' ages 
varied from 12 to 40 years, and some were of a 
strumous constitution. Total : 10 successes, and 
not a single fatal case. Dr. Servais furthermore 
states that all these patients were treated at their 
residences, and that he used the carbolic acid 
dressing, and prescribed them all a tonic regi- 
men, and allowed them to drink beer and wine 
with discretion. The pharmaceutic agent used 
was quinine in the form of tincture, in addition to 
plenty of wine. He advocates the following 
method of operating at the knee : Instead of re- 
moving the extremities of the femur and tibia by 
a horizontal section, he practices an oblique sec- 
tion, from above, down, back to front, and from 
without, Avithin. The height at which the sec- 
tion is to be made will be indicated by the exten- 
sion of the bony lesions. This he declares will 
prevent the powerful contractions of the quadri- 
ceps crural from drawing the femur outward, 
forward, and upAvard. He dispenses with the 
osseous sutures, ])ut firmly supports the bones 
against each other, which gives rise to an over- 
lapping, favorable to the formation of solid callus. 
He mentioned also that W. H. Pancoast, one of 
the most skillful surgeons of Philadelphia, stated 
that in simple fractures of the tibia, where 
the fibula remained intact, great difficulties 
would be experienced as to its consolidation. If 
in such a case. Dr. S. says, we fracture the fibula, 
henceforth nothing would prevent its consolida- 
tion, consequently the overlapping of the frag- 
ments is thus a favorable condition in the cure of 
synostosis. 



j nemannic and the Galenic laws, diametrically 
I opposed as they are, are both laws of nature. 
i as much one as the other. Nor does he even 
give any exact indication as to when similars or 
when contraries should be adopted. But what 
he aims to show is mainly that while a ' ' con- 
trary " remedy may relieve^ it is usually left for a 
"similar'" remedy to cure. This is illustrated 
by some remarkable cures of lithic acid gravel by 
small doses of nitric acid. Sir Henry Thompson 
has shown that while alkaline treatment will no 
doubt counteract the effects of uric acid, it will not 
check its formation. Dr. Kidd's contention is 
that, in such cases, as a rule, the treatment by 
acids in small doses follows the more generally 
valid law of cure. This principle is exemplified 
with respect to many other diseases, and the 
argument is supported by a large number of 
cases drawn from the author's own practice. 

It is thus seen that this writer stands exactly 
where old Michael Albertus, and for that matter 
all enlightened modern physicians have stood 
(See Reporter, vol. xxix, p. 345). Fettered by no 
exclusive dogma, tied to no limited induction, every 
clear-minded medical observer will practice by 
similars or contraries, by both or by neither, as 
his own studies and experiences suggest to him 
is most appropriate to the particular disease and 
the particular case he has before him. Often he 
willj;rust to an intelligently supervised expectant 
method alone ; and often again he will be guided 
by the result of a well established empiric method, 
which has no visible connection whatever, either 
with the doctrine of contraries or of similars. 
This is the only true therapeutical method. 



The. Laws of Therapeutics. 

Dr. Joseph Kidd, of London, the medical at- 
tendant on Disraeli, and a physician of the largest 
and most fashionable London practice (as his re- 
ported professional income of £100 per day testi- 
fies) has recently come before the public as an 
author, we believe, for the first time. He was, at 
the time he went to Berlin, reported by various 
American newspapers to be a homoeopathist, but 
in this book, which deals with the laws of thera- 
peutics, he scouts the doctrine of potencies and 
infinitesimals. He very properly avoids any com- 
prehensive and final assertion as to the universality 
of any law ; and, indeed, he finds that the Hah- 



Health Resorts in Egypt. 

In a paper before the German Association, at 
its last meeting at Cassel, Dr. Mook, who had 
spent three years in Cairo, gave his opinions about 
the suitability of that ancient territory as a resort 
for invalids, Cairo itself he condemned wholly. 
Infectious diseases are always prevalent ; the sew- 
erage is wretched, and winter and summer are 
alike trying to an enfeebled constitution. Luxor, 
where Cook's Hotel is situated, is much better, 
but fogs are common, and in winter the mercury 
often sinks to the freezing point. In conclusion, 
Dr. Mook thinks that a winter on the Nile should 
not be recommended to an invalid. The cost 
is great, conveniences scarce, the climate change- 
able. As a summer residence, Egypt has ad- 
vantages in its steady, high temperature for suf- 
ferers from chronic rheumatism, chronic pleurisy, 
and syphilitics. 



Feb. I, 1879.] 



Correspondence, 



107 



Trichina in American Fork. 

Our German exchanges note another scare 
about American pork iii Germany. In Heilbron 
the authorities made a seizure of 1250 hams and 
300 sides of bacon, recently consigned there from 
an American house, and which had escaped offi- 
cial inspection. They found 8 per cent, of the 
whole crammed with the capsules of the trichina 
{seJir stark mit Trichinen besetzt). Of course, it 
led to a strong prejudice against the whole lot, 
and a general avoidance of American pork. It 
would be very much to the interest of the pork 
producing parts of this country for Congress to 
ap]3oint experts to make a thorough study of the 
prevalence and prevention of trichinosis. In this 
connection we call attention to the alleged cura- 
tive power of ergot in the disease, which we 
mentioned once before in the Reporter. 



Curare in Epilepsy. 

Dr. C. F. Kunze, of Halle, advocates the use of 
curare in epilepsy. He says he has tried the bro- 
mides enough : they only check the attacks for a 
few months, when they return more severe, than 
ever. Curare he has tried in eighty cases, of 
which he believes six have been radically cured. 
He uses the curare thus : 

R. Curarse, 0.8 

Aquse destil, 5.0 

Mucilaginis, gtt.1-2 

For six or eight injections, one every five' days. 

The treatment is then stopped until the fits re- 
cur, when it is recommenced. 



Correspondence. 



The Management of Puerperal Convulsions. 

En. Med. and Surg, Reporter : — 

In the Medical and Surgical Reporter of the 
11th inst. is an article under the caption, "Re- 
marks on a Case of Puerperal Convulsions," by 
J. A. Rawls, M.D., which he closes by saying, 
" Now was the course pursued the best, under the 
circumstances above detailed? Editor please 
answer." I was formerly, for several years, a 
reader of the Reporter, but, as now remembered, 
never wrote a line for your columns, and as you 
have not answered Dr. Rawls, I will endeavor to 
answer him for you, provided always, that the 
answer shall be considered mine and not yours. 

It is to be regretted that the Doctor's report of 
the case is not more full, as while it is not neces- 
sary always that a report should be elaborate, yet 
the salient points should be made apparent. The 
personnel of the patient, the character of the 
pulse, the temperature, the breathing, the con- 
dition of the pupils of the eyes, whether urine in 
any quantity was present in the bladder, and the 



character of the urine, were all matters to be 
taken into account in the case, and while he no 
doubt considered them, in his written showing of 
the case they are all wanting. 

It is evident to obstetricians that perhaps a 
majority of cases of accouchment will terminate 
well and favorably with little or no attention on 
the part of the attending physician, or even in 
his absence ; yet there is a percentage of the 
cases that require the best skill and most pro- 
found knowledge of our profession ; and fortu- 
nately or unfortunately we never know in ad- 
vance what a given case will be, therefore we 
should always go prepared for the worst, and to 
go otherwise is a sin of omission, at least. Hence 
the Doctor was wrong in going eight miles into 
the country without being fully prepared for any 
possible emergency that he might have to meet. 

He was certainly right, in the absence of his 
forceps, or possibly preferable to the use of for- 
ceps, in turning and delivering by the feet, be- 
cause prompt and early delivery by any safe 
means is the sine qua non in all such cases. The 
administration of chloroform was of doubtful 
utility, to say the least, while it probably pro- 
voked or added to the lesion that eventually re- 
sulted in death, and while the use of bromide of 
potassium may have acted -favorably, it is not to 
be wholly relied on. 

The Doctor was probably wrong in chief, inas- 
much as he failed to bleed his patient, as no 
single remedy within the range of the whole ma- 
teria medica is so potent for good in this dread 
disease as the free use of the lancet, and its 
avoidance, and the attempt to supersede it by the 
use of chloroform and its kindred remedies, has 
brought to us only empty honors. 

The very fact that the patient had a respite 
from the convulsions, of two hours, after the 
uterus was emptied, with the consequent loss of 
blood, was a strong argument in favor of deple- 
tion, and the fact that death occurred so soon 
was no argument against it, particularly when 
the convulsions recurred, and to all appearances 
were the cause of death. 

But still no one can speak authoritatively of a 
case that he did not see ; the doctor present alouc 
knows or can know all the facts and features in a 
given case, and of all men, he alone can intelli- 
gently answer the question, "was the course 
pursued the best?" when he studies other cases, 
with their treatment, and in after years makes 
up a digest of them all. In this we are aided 
much by mutual criticisms, and to this end only 
is this written. Andreav J. Scott, a.m., m.d. 

Loudonvillej 0., Jan. 16th, 1879. 



The Treatment of Lupus. 

Ed. Med. and Surg. Reporter: — 

Seeing an article in your Journal of January 
11th, on the surgical treatment of lupus, which 
appears to me to be very tedious and painful, I 
am induced to report the following case which 
has recently come under my care: — 

John C, aged about forty, some two years ago 
had what he thought a wart upon the pinna of the 
ear. This wart proving troublesome he was in 
the habit of picking at it, until it became an ulcer : 
he then applied many home-made salves, but 



io8 



Correspondence. 



[Vol. xl. 



failing to heal the sore, applied to me for treat- 
ment. I was satisfied that I had a case of lupus 
to contend with, and told him it would be neces- 
sary to burn it ; this he would not agree to until 
I had given him several ointments, such as car- 
bolic, ung. hydg., ammonia, etc., to try and heal 
it. These having failed, as I anticipated, he con- 
sented to submit to any treatment I might deem 
ad^dsable. The ulcer now extended over the 
greater portion of the upper part of the ear and 
the adjacent part of the head. On the 20th Oct. , 
1878, I applied a paste made of chloride zinc one 
part, and flour three parts, as advised by Erich- 
sen, and sent him home, some five miles, with 
some morphia powders to take during the night, 
to relieve pain. On the morning of the 21st I 
visited him. He had not taken the morjDhia, say- 
ing the pain was not so severe as to require it. 
The whole of the ear and surrounding parts were 
much swollen and inflamed. Ordered flaxseed 
poultice ; the swelling and inflammation gradually 
subsided, and on the 26th the whole of the slough 
or eschar caused \)j the paste had come away, 
leaving a healthy granulating surface. I now 
ordered the application of the following ointment: 
ungt. hydrarg, nit., ^[j, cosmoline, ^j, recom- 
mended by JDr. G. MacConnell, Medical and 
Surgical Reporter, Sept. 21st, 1878. The sore 
healed rapidly, and in ten days from application 
of zinc paste the man was at work. 

If your readers will refer to the article on Sur- 
gical Treatment of Lupus, published in your 
Journal January 11th, 1879, and compare the 
treatment there recommended with the zinc paste, 
I do not think they will ever resort to the knife, 
needle, or scraper. 

The main points of interest in my case are, 1st, 
the slight amount of pain, the patient walking five 
miles after application of the jDaste, and not taking 
the morjDhia with which he had been supplied, at 
any time during treatment, though the paste was 
kept on some twelve hours, and set up considerable 
inflammation. 2d, the short time required to effect 
a radical cure of a lupus of two years' standing. 
The object in treatment is to stimulate the vessels 
supplying the part, so as to substitute active 
healthy action for the sluggish, indolent condition 
always found in lupus, therefore your paste should 
be sufficiently vStrong and applied long enough to 
set up considerable inflammation, and to pene- 
trate through the diseased to the healthy tis- 
sues, so that when your eschar comes off it may 
take the whole of the diseased part with it, other- 
wise you may have to make more than one apjDli- 
cation. Wm. F. Alexander, m.d. 

Duffield's, W. Virginia, Jan. 13, 1879. 



The Prevention of Consumption. 

Ed. Med. and Surg. Reporter: — 

Two years ago, in an article to your Journal, I 
called attention to the advantages that I had 
found by the employment of gallic acid in the 
treatment of consumption. Since that time I 
have continued its use with good results ; indeed, 
it has furnished relief when other remedies had 
failed. The ravages by this one disease are alarm- 
ing, and every means that will furnish relief 
should be employed. By the adoption of the 



astringent course of treatment much can be ac- 
complished, especially in the earlier stages or in 
those cases that are predisposed to it, thus en- 
abling the tissues to resist the development of 
these deposits. The reason I offer these suggestions 
is, that in my practice, and from information 
obtained from tanners, I have been unable to 
find a single case where a person employed about 
the vats in these manufactories has ever sufiered 
or died from the effects of this disease, and they 
are greatly exposed, as the place is always damp. 
I have found persons who had suffered in the 
earlier stages of -this affection, and who engaged 
in this business for the purpose of improving their 
health, and who obtained the desired results ; they 
all lived to an old age. The reason for this is 
due, I think, to the inhalation from these vats, 
which contains the astringents used in the prepara- 
tion of the leather. Now as these persons escape 
the ravages of this disease by these means, is it 
not natural for us to administer these astringents, 
as a means of prevention, to others who are not so 
emploj^ed? and I ask that the members of the 
medical profession will give this subject a con- 
sideration. W. H. HUTT, M.D. 
324 Federal street, Philadelphia. 



Eemarks on the Eubber Ball Pessary. 

Ed. Med. and Surg. Reporter : — 

I do not claim attention to the Ball Pessary 
because it is a new thing, but because it is a 
good thing too little used. 

Every gynecologist has cases of prolapsus uteri 
which defy the ring or Hodge pessary, and do 
not call for the cup or stem supporters. Either 
the uterus is too hea^y and sensitive for a single 
circle of support, or the enlarged and hyperaemic 
neck sags hopelessly through the support. 

Especially in the latter case will the ball be of 
value. The constant, pliant, coaxing, even 
pressure on the hypertrophied neck, is one of the 
best means for atrophy, if I may be allowed the 
perversion of the word, the ball taking advan- 
tage of every yielding of tissue to gain ground 
and keep it. Not only will the neck shorten, not 
flatten, but the whole body will slowly rise, the 
more the longer the ball is retained, instead of 
sagging, as in the protracted use of other sup- 
ports I know. 

Old cases of prolapsus with hypertrophy, and 
supposed contraction of ligaments, yield to the 
ball after the failure of the best pessaries. 

In some cases its use sets up a profuse serous 
or sanguineous discharge from the uterus which, if 
the ball be retained meanwhile and during the 
succeeding menstrual period, will reduce the 
organ to normal size in half the time it can be done 
by medicated suj)positories. 

Choose a simple rubber ball, such as children 
play with, of black or white rubber ; the flexi- 
iDility and diameter to suit the case. After a few 
days* retention, a larger size can frequently be 
employed. 

Expel the air from the ball with thumb and 
finger of left hand, fold the ball with sanie of 
right hand, smear with cosmoline, keep its oper- 
culum in plane of osteum vagina ; have patient 
in knee-elbow position, vagina well opened ; insert 



Feb. I, 1879.] 



News and Miscellany, 



109 



folded ball, allow it gradually to fill with air. 
The disagreeable pressure on neck of bladder 
and rectum soon lessens and disappears as the 
ball works up. 

Medicated enemeta may be used while the ball 
is in situ, if the syringe tube is carefully managed. | 
Astringent suppositories should supplement the | 
effect of the ball on its removal, which the patient i 
can sometimes accomplish by straining at stool, j 
or the physician by refolding the ball in situ, a | 
difficult matter I must acknowledge, and with- i 
drawing it as inserted, only having the patient on | 
the back or side. A. A. G. 

Elmira, X. Y. Aug. 7th, 1878. 



Cysto-Sarsoma (?) of Ovary. 

Ed. Med. axd Surg. Reporter : — 

Mrs. Josephine J., thirty years of age, mar- 
ried, was by me delivered of her second child, a 
male, on May 28th, 1874, after a labor of eighteen 
hours, which was followed the day succeeding by 
a very severe general peritonitis, lasting about 
ten days. A period of three years elapsed, dur- 
ing which I saw little of her ; when, in May, 
1877, she had what appeared to the practitioner 
who attended her a miscarriage — there being 
pain, hemorrhage and reduction of abdominal 
development, though I think no foetus was found. 
Soon after the abdomen again commenced to en- 
large ; and a rumor of extra-uterine pregnacy 
prevailed. On taking charge of her case, on 
January 1st, 1878, the following history was ob- 
tained : She felt a ''burning pain'' in the right 
iliac region soon after her miscarriage; the abdo- 
men then commenced to enlarge, until it is now 
painfully distended ; the catamenia are regular, 
the urine scanty, the appetite diminished, and 
the powers of life deteriorated. The abdominal 
distention presents prominently in front, arid 
does not flatten out when the patient lies upon 
the back. Palpation gives unequivocal e^'idence 
of a large collection of fluid. For the relief of 
urgent symptoms, I performed paracentesis ab- 
dominis, January 8th, removing several gallons 
of chocolate-colored liquid, a portion of which, 
on being heated, proved to be almost wholly 
composed of albumen. The operation was re- 
peated Jttly 26th, September 5th, October 2d, 
and October 28th, the sufferer dying of exhaus- 
tion on November 6th. 

The autopsy showed entire absence of cyst, 
and complete destruction of abdominal perito- 
neum, its site being strewed with nodules, one of 
which, the size of a native walnut, was attached 
by a short, slender pedicle. There was a large 
quantity of flttid, with a copious sediment of 
broken-down, flocculent material, the removal 
of which disclosed a tumor occupying the entire 
pelvic canity, which, from its color, consistence 
and rounded exterior, resembled the brain. Its 
appearance, and the history of the case, led me 
to conclude that it was a cysto- sarcoma of the 
right ovary. E. T. Blackwell, m.d. 

Hackettstoim, N. J. 



News and Miscellany. 



Philadelphia County Medical Society. 

The annual meeting of this Society was held 
Jan. 22d, at the Hall of the College of Physi- 
cians. The following were elected as officers for 
1879: President, Henry H. Smith, m.d.; Vice- 
Presidents, John H. Packard, m.d., Robert BurnSj 
M.D.; Treasurer, Wm. M. Welch, m.d.; Corres- 
ponding Secretary, Wm. Goodell, m.d.; Record- 
ing Secretary, Chas. B. Nancrede, m.d.; Assist- 
ant Recording Secretary, Joseph D. Nash, m.d.; 
Reporting Secretary, Frank Woodbury, m.d.; 
Librarian, M. O'Hara, m.d.; Censor, M. St. 
Clair Ash, m.d. , 

Delegates were also chosen to represent the 
Society at the next meeting of the Pennsylvania 
State Medical Society and of the American Medi- 
cal Association. This is the third election of 
Professor Henry H. Smith to the position of pre- 
siding officer of the Society. Dr. Smith, upon 
taking his seat, made a brief address, in which 
he thanked the society for this evidence of their 
continued confidence. During the last year the 
number of members has been steadily increasing, 
and now numbers over 2ft0. 

A mutual aid association has been formed, 
which promises to be useful in looking after the 
widows and orjjhans of deceased members. The 
library, which was originated during the year, 
has now a considerable ntimber of valuable vol- 
umes._ The work of the Society has been steadily 
carried on ; scientific papers being read on the 
second and fourth Wednesday of every month, 
excepting July and August. 

A conversational meeting was held later in the 
evening, at which a large number of physicians 
were present. 

Dr. M. O'Hara read a description of a " Case 
of Penetrating Wound of the Spinal Marrow," 
the patient being presented to the Society for ex- 
amination. 

Dr. Chas. D. Mills also read a paper on " The 
Localization of Diseases of the Brain," with the 
records of several cases, which elicited some 
general discussion. 

The Secretary announced the death of Prof. 
John B. Biddle, m.d., a member of the Society. 

The President appointed Prof. Ellerslie Wal- 
lace, M.D., to prepare an obituary notice :"of Dr. 
Biddle to be sent to the Society of the State of 
Pennsylvania. 



— In a \illage with a population of not over 
200, in Crawford county, seventeen children died 
in one week, with diphtheria. 



Value of a ''Mad Stone." 

The Waco, (Texas) Examiner, of recent date, 
contains this item : Dr. B. F. Graves, the drug- 
gist, yesterday paid Mr. Weir, of Brown county, 
the roimd sum of two hundred and fifty dollars 
for a stone — reputed to be a veritable mad stone. 
Mr. Weir, we are told, found the stone in the 
stomach of a de>er, in Arizona county, several 
years ago, and we are further informed that it 
never fails to extract the poison of mad dogs, 
snakes, tarantitlas, and other venomous reptiles, 
insects and animals. The Doctor will keep the 
stone at his store, for the benefit of any one who 
may wish to test its virtues. 



i 



no 



News and Miscellany, 



[Vol. xl. 



obituary Notices. 

— Dr. Jacob Bigelow died at his residence in \ 
Boston, on January lOth, at the age of ninety- j 
one years. He was the oldest member of the 
Massachusetts Medical Societ}^, and one of a i 
group of prominent men whose lives are inti- 
mately connected with the early history of medi- | 
cine in this country. Born but a few years after I 
the Revolution, and graduated at Harvard in the ! 
class of 1806, his literary career began as early 
as 1814, with a work on botany, entitled Florida 
Bostoniensis, which to this day is the most com- 
plete work of its kind, and the standard author- 
ity. He was already a professor in 1815, and a 
few years later his beautiful plates of American 
Medical Botany made their appearance. His 
early lectures on the applica1:ion of science to the 
useful arts gave a bent to his tastes and views, 
which ultimately terminated in his participation 
in the inauguration of the Institute of Tech- 
nology. 

— Dr. W. T. Nealis, who was for a number of 
years physician in the New York City Pi-ison, 
died at his home, in that city, last week. Dr. 
Nealis was for four years Surgeon of Corcoran' s 
Irisli Legion. 



brandy at $10, and ale, beer, etc., at |20 a barrel ; 
while the English excise returns show a consump- 
tion of liquor of the value of $710,041,155. Taking 
American quantities at English prices, Mr. Saun- 
ders of London declares that if the Englishmen 
only drank as much as Americans they would ex- 
pend annually only |340,000,000. 



Sanitary Protection Associations. 

An association of the above character has been 
organized at Newport, B. I., of which Dr. Hora- 
tio R. Storer is one of the leading spirits. It is 
of such an enlightened and valuable character 
that it deserves general imitation. Its objects 
are, briefly — 

1st. To provide its members, at moderate cost, 
with such advice and supervision as shall insure 
the proper sanitary condition of their own dwell- 
ings. 

2d. To enable members to procure practical 
advice, on moderate terms, as to the best means 
of remedying defects in houses of the poorer 
class, in which they may be interested. 

3d. To aid in improving the sanitary condition 
of the city. 

A pamphlet containing the details of the or- 
ganization can be had by addressing the Corres- 
ponding Secretary, Dr. H. R. Storer, at New- 
port. 



The Plague in Europe. 

ViEXNA, Jan. 22. — Preliminary conferences in 
regard to the plague have commenced between 
the German Privy Councillor, Finkelnburg, and 
the members of the Austrian Sanitary Board. 

The establishment of a rigorous sanitary cordqn, 
with the co-operation of Roumania, from Memel 
to Sulina, is suggested. 

Astrachan and vicinity have been severely at- 
tacked with the disease in a malignant form. 



Consumption of Alcoholics. 

On the authority of Mr. Nimmo, of the Ameri- 
can Bureau of Statistics, the people of the United 
States consume liquor costing them (at retail 
price.) $595,784,784 a year, whisky and suchlike 
spirits and wine being estimated at |6 a gallon, 



Vital Statistics of London. 

During the fifty-two weeks of 1878, 83,695 
deaths were registered in London, of which 14,734, 
or 18 per cent. , were referred to the seven princi- 
pal zymotic diseases; the death-rate from all 
causes was equal to 23.5, and from the seven 
principal zymotic diseases to 4.1 per 1000 of the 
23opulation, against 21.9 and 3.5 respectivelv in 
1877. 



Items. 

— In the case of Aiken vs. The Illinois State 
Board of Health, the appellate court has just 
rendered a decision sustaining the ruling of the 
lower court, and thus further confirming the board 
in its right under the law, for unprofessional con- 
duct, to deprive a practitioner of his license to 
practice. 



MARRIAGES. 



Barton"— Church. — At tlie residence of Mr. Horace 
Churcli, in Pomerov. Meigs Co., O., January 12th, 1879. 
by Rev. W. J. G-riffith, Mr. Thomas H. Barton, m.d., 
of Syracuse, O., and Amanda Church, of Pomeroy, O. 

GriLFiLLEN— Campbell.— At Carlisle, Brown county, 
O., January 2d, 1879, by Rev. J. H. De Bruin, A Gil- 
fiUen, M.D., and Miss Ascenith A. Campbell. 

Post— M'CoNAUGHY.— By Rev. John McMillan, d. 
D., in the Reunion Presbyterian Church, Mt. Pleasant, 
Pa., on the 1st of January, 1879, Judge G-eorge W. Post, 
of York, Nebraska, and Miss Laura, daughter of Dr. 
James M'Conaughy, of Mt. Pleasant. 



DEATHS. 



Altrocchi.— A* Stamford, Conn , on Thursday, the 
9th inst., of pneumonia, Annie G-ertrude, wife of Nicola 
Altrocchi, and daughter of Dr. H. M. and Ann Olivia 
Humphrey, aged 28 years. 

Baylor.— In Denver, Colorado, on January 13th, 
1879, Dr. John C. Baylor, of Norfolk, Va. 

Dow.— At Hillsdale, Columbia county, N. Y., on 
January 14th, 1879, Joseph P. Dow, m.d., aged 73 years. 

Harding. — Suddenly, at the residence of his father, 
Dr. M. H. Harding, Sr., Laurenceburg, Ind., on the 
morning of the 12th inst., of diphtheria, after two days' 
illness, M. H. Harding, Jr., m.d, aged 24 years, gradu- 
ate of the Ohio Medical College, 1878, and just entering 
upon the practice of his profession. 

liAUGHLTN.— At his residence, in Bloomington Mc- 
Lean county. 111., December 6th, 1878, of neuralgia of 
the heart, Dr. R. G-. Laughlin, in the 51st year of his 
age. 

L'HoMMEDiETJ.— At the Fifth-Avenue Hotel, N. Y., 
of pneumonia, after six days' illness, Mrs. Emmeline 
L'Hom~medieu, wife of Dr. Samuel L'Hommedieu. 

MixsELL. — At Mamaroneck, N. Y., January 13th, 
Worden Jackson, only son of Dr. A. J. and Lou Mix- 
sell, aged 2 years, 5 months and 15 days. 

Peterson.- On November 19th, 1878, of phthisis, Dr. 
J. J. Peterson. 

Rannet.— Henry D. Ranney, m.d., of New York city, 
on the 11th inst., aged 61 years. 



yr -^ cz^'^^ jyi^/ y *^ ¥-^iyA^ a^ 



^^i^;;:^ 



C^t^^C-^A^i-y^^^^^ >^.^^<g^X 



f^ WHOLE No. 1140] FEBEUART 8, 1879. 



[VOL. 'XI.; No. 6. 




THCiB 



MEDICAL AND SURGICAL 

IREFOIRTEIE^ 

A. ^^EEKLY JOTJIi:iSrA.L, 

EDITED BY D. G. BRINTON M. D. 



Terms of Sabscrijilion, FIT£ DOLiIiARS per annnm, in advance.— SIng-Ie Copies Ten Cents. 



C O IV TETSTTS 



OEIGINAL DEPARTMENT. 

LECTURE. 

Smith, Robert Meade.— Experimental Physiol- 
ogy—Physiology of the Salivary Secretions Ill 

COMMUNICATIONS. 

Vance, Reuben A. — Inversion of the Human 
Bladder 115 

HOSPITAL REPORTS. 

Philadelphia Hospital— Surgical Clinic of Dr. John 

H. Brinton— Frostbite— Coxaigia 118 

New York Hospital— Clinic of L. Duncan Bulkley, 

. M.D.— Diseases of the Skin— Psoriasis— Psoriasis in 

Stage of Decline— Syphilitic Onychia— Infantile 

Urticaria— Syphilitic Bursitis— General Papu lar 

Syphilide 121 

EDITORIAL. DEPARTMENT. 

PERISCOPE. 

Chronic Intermittent Albuminuria of Adolescents 123 

On Antecurvature of the Uterus 124 

The Use of the Forceps when the Os Uteri is Par- 
tially Dilated 124 

The Action of Large Doses of Capsicum 124 

REVIEWS AND BOOK NOTICES. 

Notes on Current Medical Literature 125 

BOOK NOTICES. 

Medical Chemistry (Wheeler) 125 

An Atlas of Human Anatomy (G-odlee) 125 



editorial. 

The Theories of Epidemiology. 126 

notes a^n'd comments. 

Remarkable and Gratifying Change 127 

Hereditary Transmission of Heart Disease ..... 127 

Pilocarpin as an Abortifacient 127 

On the Treatment of Ulcers 128 

Induced or Symmetrical Anaesthesia 128 

The Croton Oil Treatment of Naevus 128 

CORRESPONDENCE. 
The Antagonism of Alcohol to the Poison of Diph- 
theria (Nowlin) 128 

Retained Placenta (DeArmond) 129 

Dangers in the Use of Calcined Magnesia as a Lax- 
ative (a. A. G.) 129 

Case of Epilepsy, with Treatment (Casselberry) .. 129 
The Gynecological Wire Loop (Folsom) 130 

NEWS AND MISCELLANY. 

Report of the Board of Experts Who Have Been 

Investigating the Yellow Fever Epidemic 130 

Personal 131 

Smallpox in Brazil 131 

The Medical Staff of the Russian Army 131 

Notes on Health Resorts. ; 131 

Obituary Notices— Dr. JohnB. Blddle— Dr. Nathan 

Mitchell— Dr. Tardieu— Dr. S. H. Shannon 131 

Queries and Replies 132 

Marriages and Deaths ..'.'. 132 



Established in 1853, by S. W. BUTLER, M, 

PHILADELPH I A : 
Published at No. 115 South Seventh Street. 





>^ 



Press of Wm. F. Fell & Co., 733 Sansom St., Philadelphia. 



REMITTANCES RECEIVED. 

Week Ending February I, 1879. 

y. B.—All Checks and p. 0. Orders must be drawn 
payable to the order of D. G. Brinton, m.d. 

4®^ Subscribers are requested to inform us immedi- 
ately if their remittances are not acknowledged in this 
column. 

Alabama.— Drs. R. A. Jones, S. E. Cross. California. 
— Drs. C. B. Brcwn, W. W. Hays. Canada.— Dr. T. 
Hosack. Connecticut.— Drs. J. O. Boles. J. B. Der- 
rickson. Delaware.— Drs. F. J. Owen, O. Henry. 
Colorado.— Dt. 3. Hawes. Georgia.— I>ts. B. R. Bos- 
ton W. .T. Johnson. Illinois.— l>rn. J. D. M. Carr, J. 
B. Knapp, H. B. Sikes, J, J, Lobaugh. Indiana.— 
Drs. I. Y. Smith, A. JR. Byers, H. Ader, L. O. Neal, 
I. Hawkins, M. Shepherd, J. M. Adams, Tyner & 
Jones. Iowa.— Drs. S. H. Sawyers, O. W. Manker, 
Norris &Son, Stults & Son, J. N. Day, E. A. Chap- 
man, D. C. Brockman, E. S. Carlisle, M. .T. Powers, 
O. B. Jennings. Kentucky.— Drs. J. W. Becker, Mar- 
tin & Toon, 0. Sauter, H. Brown. Louisiana.— Dr. 
O. P. Langworthy. Maine.— Dr. S. Laughton. Mas- 
sachusetts.— Dr. E. A. Chase. Michigan.— Drs. A. 
Garlock, O. Marshall, W. H. Bills, H. L. Young, E. 

B. Chapin, C. W. Backus. Minnesota.— Dra. J. H. 
Tilford, O. H. McMichael. Mississippi.— Drs. W. 
H. Harrington, J. M. Hicks, B. Shepherd. Missouri. 
—Drs. Folmsbee & Allen, J. W. Cannon, B. St. G. 
Tucker. New Hampshire. — Drs. J. A. Davis, J. L. 
Patten, S. C. Whittier. New Jersey.— Drs. J. W. 
Snowden, H. W. Elmer, B. Reed, C. L. Fisler, W. J. 
Lytle, N. B. Jennings. New York.— Drs. J, H. Steb- 
bins, J. Parr, W. D. O. Brien, W. J. Haine, R. H. 
Morey, Caswell, Hazard ficCo^ N. Y, Pharmacal As- 
sociation, Scott & Bowne, E. Fougera & Co. North 
Carolina. — Dr. R. L. Payne & Son. Ohio.— Dra. A. 
N. Wylie, A. F. Willson, J. Sauns, S. D. Smith, J. S. 
McBean, A. W. Calvin, F. W. Fletcher, L. B. Tuck- 
erman, E. A. Farquhar, Cincinnati Library Hospital, 
Mr. P. W. Garfield, R. Clarke & Co. Pennsylva- 
nia.— Drs. G. A. Fiske, W. H. Tracy, R. B. Fruit, S. 
K. Barndt, C. M. Porter, H. D. Heller, T. Galbraith, 
O. W. Krise, T. T. Martin, A. J. Martin, D. D. Loop, 
J. K. Griffin, J. A. Brown, E. W, Riggs, J. K. Reid, 

C. G. Treichler, S. J. Gruver, A. J. Kautz, I. H. 
Moore, A. F. Balmer, J. W. Moore, E. H. Horner, J. 
B. Tweedle, J. W. Greenfield, W. Lemmen, J. F. 
Arnold, J. F. Murphy, J. "VV. Leadenham, H. D. 
Reutschler, Geo, Ross, D. W. FoUweiler. Rhode 
Island.— Dr. G. S. Stevens. South Carolina. — Dr. 
A. M. Forster. Texas.— Drs. J. H. Sears, Eads & 
Pope, J. R. Taylor, J. M. Blair, R. W. White, S. J. 
Perkins, W. D. Holleman. West Virginia.— Drs. L. 
A. Davidson, D. P. Morgan. Ver7nont.— Drs. E. J. 
Hall, J. S. McBean. Wisconsin.— Drs. .T. E. Gee, 
National Hospital. OFFICE PAYMENTS.— Drs. 
R. Burns, A. Schott, W. H. McAlarny, Preston Re- 
treat. 



SYRUP-GLYCEROLE 



WYETH'S COMPRESSED TABLETS 

ov 

CHLORATE OF POTASH. 



For Uoarsenei^s, Bronchial Irritntion, 
Sore Threat, Diphtheria, Cronp, etc>« etc. 



Chlorate of Potash is a remedy of acknowledged 
value in cases of Diphtheritic Sore Throat, and in 
Inflammation of the Mouth and Throat, induced by a 
depressed stp-te of the system. In these instances, as 
in the milder forms of Croup, it has, besides its depur- 
ative and detergent effects, a solvent action on the de- 
posits, characteristic of those troublesome and danger- 
ous aff'ections. It relieves Hoarseness ; and in many 
cases of Fetid Breath from disordered secretions It 
proves an efficient corrective. Its virtues in simple 
Angina, or ordinary Sore Throat, are recognized by 
many of the most eminent physicians. 

As the taste of this article is not disagreeable, we 
have prepared it in the form of Compressed Tablets, 
thus giving the patient the full benefit of its action, 
undiluted with Sugar, Gum, or other vehicles, which 
would not only prevent its effects, but which some- 
times themselves offend the stomach. 

The Lozenges usually contain about twenty-five (26) 
grains of gum and sugar, with two grains of the Chlo- 
rate of Potash, while each of these Tablets contains 
simply five grains of the Chlorate, all of which, dissolved 
in the saliva, acts on the affected mucous membranes. 

If allowed to dissolve in the mouth, the topical effect 
is much more efficient than a saturated solution, as, 
while the solution is but temporary, the tablet really 
acts as a continuous gargle. ~R 




The Combination which all Forms of Iron 
must assume before Assimilation. 

Superior to all other Iron Salts, in that, ichiJe it 
is readily taken into the circulaiion, and does 
refemiginate the blood, it does not ordinarily 
cause coiistipation nor headache. It is very 
pleasant to the taste, and is unalterable. 

Ferrous Chloride is a neutral salt, consequently it 
has no action upon the teeth, and may be admin< 
istered fearlessly. This fact and the delightful taste 
of my preparation render it an advantageous form 
for administration to children. Each fluid drachm 
contains one grain of Ferrous Chloride, which, 
owing to the certainty of its assimilation, is a full, 
active, adult dose. 

McKELWAY, Apothecary, 

Successor to O. S. HUB BELL. 

1410 CHESTNUT ST., PHILADELPHIA. 



FOR !SOR£ THROAT, HOARSENESS. 

DIRECTIONS:- Adults should take one every 
hour or two until relieved, allowing it to dis- 
solve slowly in the Mouth. Children half of one 
as often. 

For OflFensive Breath, no remedy will give 
more certain relief ; use one, two or three times 
a day. 

For Diphtheria, Croup and the more serious 
ailments, the physician should direct. 



PEPTONIC PILLS. 



Pepsin, Pancreatiu ^ith I^acto* Phosphate 
of Uine and liSictic Acid. 



(COPYRIGHT SECURED.) 

This pill will give immediate relief in many forms 
of Dyspepsia and Indigestion, and will prove of perma- 
nent benefit in all cases of enfeebled digestion, pro- 
duced from want of proper secretion of the Gastric 
Juice. By supplementing the action of the stomach, 
and rendering the food capable of assimilation, they 
enable the organ to recover its healthy tone, and thus 
permanent relief is afforded. One great advantage of 
the mode of preparation of these pills is the absence of 
sugar, which is present in all the ordinary Pepsin and 
Pancreatic compounds. In this form, the dose is much 
smaller, more pleasant to take, and is less apt to of- 
fend the already weak and irritable stomach. The 
results of their use have been so absolutely satisfac- 
tory, that we are confident further trial will secure for 
them the cordial approval of the Medical Profession 
and the favor of the general public. 

Each pill contains one grain of pure Pancrkatin, 
which is equivalent to 10 grains of the ordinary or 
Saccharated usually prescribed and dispensed. Physi- 
cians will appreciate the great advantage of this mode 
of administration, the increased benefit to the dyspep- 
tic being due to a full and effective dose of each, freed 
from unnecessary bulk, and really hurtful addition of 
sugar. A single pill will give immediate relief. 

DIBECTIONS :— Take cne pill imn^ediately 
after eating or when suffering from Indigestion, 
Lump in the Throat or Flatulence. For child- 
ren, reduce the pill to powder and give one- 
fourth or half) according to age. 

JOHN WYETH & BRC, 

nu-eow Chemists, PHII.ADEI.PHIA. 



THE 



MEDICAL AND SURGICAL REPORTER. 



No. 1145.] 



PHILADELPHIA, FEB. 8, 1879. 



[Vol. XL.— No. 6. 



Original Department. 



Lectures 

ON 

EXPERIMENTAL PHYSIOLOGY. 

Delivered in the Physiological Laboratory of the Uni- 
versity of Pennsylvania, 

BY ROBERT MEADE SMITH, M.D., 

Demonstrator of Experimenfal Physiology in the Uni- 
versity of Pennsylvania. 
Eeported expressly for the Medical and Surgical 
Reporter. 

Lecture II — Physiology of the Salivary Secretions. 

(Continued from Vol. xxxix, p. 534.) 
We will take up to-day, gentlemen, the study 
of the special physiology of the individual sali- 
vary secretions, commencing with that of the 
parotid gland. 

The human parotid saliva can readily be ob- 
tained in a state of purity by catheterizing Steno'^s 
duct. This can be accomplished in the follow- 
ing manner: the experimenter sits opposite a 
mirror, with the mouth open and brilliantly illu- 
minated. If now an angle of the mouth be 
drawn outward and forward, so as to stretch the 
cheek, the papilla which marks the entrance of 
Steno's duct into the mouth will be seen opposite 
the second molar tooth of the upper jaw. With 
a little practice a small canula can be readily in- 
serted into the duct, the opening of which is 
marked by a little dot, and held in position to 
catch the saliva, which will then flow along the 
tube, if its flow be stimulated by the vapor of 
ether, pyrethrum root, vinegar, etc. It is easier 
to catheterize another, but with a little practice 
the operation can be performed quite readily on 
one's self. One precaution, however, must be ob- 
served, to ensure reliability of result. Occasion- 
ally the parotid duct receives, near its entrance 
111 



into the mouth, the secretions of several small 
muciparous glands; to avoid, therefore, the 
modification of the parotid saliva which would 
be caused by the admixture of mucus from this 
source, the catheter must be carried as deeply 
as possible, so as to pass the opening of these 
ducts. 

My assistant. Dr. Foulkrod, has been kind 
enough to allow me to show you on him the 
steps of this little operation. The canula is in- 
serted with the greatest ease, and without any 
pain or discomfort. I place a drop of vinegar 
on his tongue ; the saliva is abundantly secreted, 
and flows along the tube. 

Here is a specimen of human parotid saliva 
obtained in this manner, and you see that it 
differs from the mixed saliva in that it is per- 
fectly clear, without turbidity or opalescence, and 
that it is much more watery. It is also alkaline. 
It was formerly supposed that the parotid saliva 
had no influence on starch ; we will examine this 
specimen, following the process with which you 
are familiar. In a few moments we find evi- 
dence of sugar. Another peculiarity of the 
parotid saliva is, that although sulpho- cyanide of 
potassium has been found upon chemical analy- 
sis, there exists in the parotid saliva some other 
substance that masks its reaction with the per- 
chloride of iron. In this instance the addition 
of a solution of the salt does not produce the 
beautiful red color which you saw follow the 
same combination when mixed saliva was sub- 
stituted for the parotid. 

The study of the various natural conditions 
which serve as stimulants to the individual sali- 
vary secretions can be best carried on in the 
lower animals: for this purpose we receive the 



112 



Lecture, 



[Vol. xl. 



secretion before it becomes mingled with the 
fluids of the mouth, by means of salivary fistulae, 
the operation for which I will now show you. 
To make a parotid fistula in a dog, the animal 
usually employed in these experiments, the hair 
is first shaved from the cheek between the eye 
and the angle of the mouth. On running the 
finger along the lower border of the zygomatic 
arch, just before it is inserted into the superior 
maxilla, a slight notch is felt ; it is just at this 
point that the duct passes into the mouth. After 
chl(?roforming the animal, I will make an incision 
through the skin over this point, cutting obliquely 
in a direction from the inner canthus of the eye 
to the angle of the mouth, passing through the sub- 
cutaneous cellular tissue, when the facial artery 
and vein, branches of the facial nerve and the 
parotid duct are found all together; the duct, 
pearly white in hue, passing horizontally across 
the fibres of the masseter muscle, parallel to the 
nerve, but usually about a quarter of an inch be- 
low it, while the artery and vein run from above 
downward. The vessels and nerve must be 
carefully removed from before the duct, which 
is to be isolated and closed as near the mouth as 
possible with a clip. A canula can then be in- 
serted into the duct. If it is desired to retain 
the fistula permanently, the duct must be freed 
from the connective tissue for as long a distance 
■as possible, divided, and one end brought out at 
an angle of the wound, which is to be closed 
with sutures, one passing through the duct to 
retain it in position. After a few days, when 
the wound is healing, the duct will mortify and 
drop out, leaving a fistulous track to the gland, 
which must be kept open by the daily passage of 
a fine probe, as it has a decided tendency to close. 
In this other dog, which I now show you, I made a 
parotid fistula in the manner just described, as well 
as a sub-maxillary and sub-lingual fistula, several 
weeks ago, and you see the animal is in very 
good health and spirits, while the wounds have 
all closed, with the exception of the ducts, which 
remain fistulous, the surrounding parts appearing 
perfectly normal. It is much better to experi- 
ment on dogs which have not been lately operated 
on, as in them there is no danger of the effects 
of the operation modifying the results of our in- 
vestigations. 

Sub-maxillary and sub-lingual fistulae are made 
in the following manner. The same animal 
being chloroformed, and the hair shaved from 
the under surface of the lower jaw, an incision 
is made along the inner border of the ramus of 
the lower jaw, from the anterior insertion of the 
digastric muscle, forward, for about two inches, 



dividing the skin and platysma, every vein that 
comes into view being secured with two ligatures, 
and divided between them. The mylo-hyoid 
muscle is now in view, and is to be very cautiously 
divided at its middle, avoiding the mylo-hyoid 
nerve, which you see lies upon it. Underneath 
this muscle will be found the sub-maxillary and 
sub-lingual ducts, running forward side by side, 
near to the ramus of the jaw, to enter the mouth : 
the sub-maxillary duct being somewhat the larg- 
est and lying nearest the jaw. The ducts can 
now be isolated and divided, and treated as you 
have just seen me do in making a permanent 
parotid fistula. When, however, as in this case, 
it is desired to make both fistulse in the same 
animal, the two fistulee should be on opposite 
sides of the mouth. 

Let us now study the effect of different stimuli 
on the secretion of these glands, in the manner 
proposed by Schiff", using the dog which bears 
the three fistulee, and isolating as much as prac- 
ticable the action of the different agents. 

The channels through which these glands may 
be excited are four in number ; 1st, through men- 
tal impression, as sight or smell ; 2d, by masti- 
cation alone ; 3d, through taste alone, and 4th, 
through the influence of taste combined with 
movements of mastication. 

You observe now, gentlemen, that the orifices 
of these glands are almost completely dry, and 
that pressure along the course of the ducts brings 
out only a single drop from the parotid duct. I 
will wipe it away with a sponge, and dry com- 
pletely each of the other orifices. 

While the dog, which has fasted since yester- 
day, is held, I hold before him, at some distance, 
a bone ; he shows signs of impatience, but there 
is no flow of saliva from the parotid, or sub- 
maxillary or sub-lingual, at least, none that we 
can appreciate. I now approach the bone to the 
dog's nose, holding his jaws so that no movement 
of mastication can be made, and there is still no 
secretion, a result which you know is contrary 
to the instances in man, in whom the mouth waters 
at sight and odor of savory food. But, however, 
we have seen inthe dog, in whom perhaps it is 
hardly fair to study mental processes, that sight 
and smell have no effect on the secretion of 
saliva. 

I open now the mouth of the animal, and place 
transversely across his jaws a light splinter of 
wood, taking care not to put it so far back as to 
press on the salivary papillae, and on approach- 
ing the bone to the animal's nose, the splinter is 
broken into fragments by the movements of his 
jaws in the attempt to get at the bone. We have 



Feb. 8, 1879.] 



Lecture, 



113- 



here, then, produced motions of mastication with- | 
out any influence on the sense of taste ; there! 
appears a single drop of saliva at the orifice of j 
the parotid duct, and, if anything, a little larger 
drop at that of the sub-maxillary, while none is 
seen at the sub-lingual. "We have here a depar- 
ture from the strict line of function drawn by 
Bernard. He taught, and has been followed 
almost universally and unquestioned, that the 
parotid secretion was concerned in mastication 
alone, and was secreted only by movements of 
mastication ; we have already seen that it is not 
the parotid alone which is influenced by these 
movements, but that the sub-maxillary is also 
affected, though both glands are but sligJitly stim- 
ulated. Let us now see what is the result of 
isolated excitations of taste. 

T\"hile holding his lower jaw, so as to prevent 
all movements of mastication, I place on the tip 
of his tongue, by means of a glass rod, a few drops 
of strong vinegar, when almost immediately a 
drop of fluid appears, not only at the orifice of 
the parotid duct, but also at that of the sub- 
maxillary ; it is succeeded by another, and again 
another in rapid succession, quite a stream of 
saliva running across the animal's jaws. A few 
drops of a strong decoction of colocynth applied 
to the base of the tongue, is followed by a de- 
cided flow of saliva from both glands, while, as 
far as we can judge, the sub-lingual is entirely 
inactive. We have seen, then, that the sense of 
taste alone is capable of exciting the secretions 
of the parotid and sub-maxillary glands in about 
equal degrees. 

I will now give the bone to the animal, and you 
see he masticates it with avidity, in spite of the ele- 
vated position in which I hold his head. And 
now the secretion from both glands is very 
marked, running down his neck on to the table, 
a decidedly more profuse secretion than we saw at 
any time before. There is also a very viscid 
drop of saliva at the orifice of the sub-lingual 
duct. 

You have now seen that the secretion of 
each of the salivaiy glands receives the most effi- 
cient stimulus when movements of mastication 
are combined with the appreciation of a '^ taste." 
These results show, as was first pointed out by 
Schiff, that the line of demarcation drawn by 
Bernard between the functions of these glands 
cannot be strictly adhered to. The parotid, as I 
have told you, was supposed to be only con- 
cerned with the mastication of food, and attains 
its highest development in the animals which 
have to grind their food ; the sub-maxillary was 
supposed to be only concerned in the apprecia- 



tion of taste, and in comparative anatomy it dis- ■ 
appears entirely when there is no need of this^ 
sense, as in gramnivorous birds, while it attains 
its greatest development in the carnivora. 
Finally, the sub-lingual secretion was held only to ■ 
be secreted for the purposes of deglutition. Al- . 
though there is doubtless considerable force in 
these statements, I have shown you that the iso- 
lation of their role has been exaggerated. 

While on this subject, let me show you another 
experiment in reference to the secretion of the. 
parotid saliva. I will give him one end of this • 
hard bone to chew, retaining my hold of the . 
other end, and change it from one side of his 
mouth to the other; you see that the flow of.- 
parotid saliva attains its maximum when the ■ 
masticating movements are made on the side of/ 
the fistula, though that of the sub-maxillary 
does not appear to be altered. This peculiarity . 
has not been sustained in man in those instances ; 
in which parotid fistulse have permitted a study > 
of the salivary secretion. 

Dalton, however, states that by catheterizing 
the parotid duct in man he was able to notice the • 
same relation between the secretion of saliva and 
the direction of mastication. The parotid saliva . 
of the dog does not act on starch. 

In the rabbit the small size of the parotid duct, 
prevents the insertion of a canula, but the se- 
cretion can be studied by cutting the duct across. ■ 
In the rabbit the duct has the same anatomical 
relations as in the dog. It crosses the masseter.. 
muscle at about its middle, accompanied by . 
branches of the facial nerve, and parallel with ; 
the transverse facial artery. At the anterior- 
margin of the masseter it dips toward the me- , 
dian line, to enter the mouth. I have here a large 
rabbit fastened on Czermak's holder and chloro- 
formed. After clipping off the fur from its cheek. 
I make a vertical incision in the line of the 
cornea, through the skin and connective tissue 
down to the masseter muscle, thus dividing the- 
duct as well as the facial nerves and blood ves- . 
sels. ^Tien the bleeding stops we can examine 
the secretion of saliva. Since we are unable to -. 
collect the secretion, probably the best way of. 
rendering the secretion visible is to put over the 
end of the duct a small piece of bibulous paper, 
colored red with litmus. As each drop of saliva 
escapes from the divided end of the duct, it is 
absorbed by the paper, and by its alkalinity pro-, 
duces a blue spot, the size of which varies with 
the rapidity of secretion. The animal has now. 
come up from the chloroform, so we can study ^ 
the various stimuli. A drop of acetic acid ap- 
plied by means of a glass rod to the tip of the 



114 



Lecture. 



[Vol. xl. 



tongue causes the appearence of quite a large 
drop of saliva ; an alkali produces a smaller 
drop, while electrical stimulation of the tongue 
and inside of the cheeks hardly seems to increase 
the flow. I will again use this same animal, in a 
few moments, in another connection. 

The sub-maxillary saliva in man may be ob- 
tained in a state of purity, either by catheterizing 
the duct of Wharton, a proceeding of consider- 
able difficulty, or by withdrawing it by means of 
a syi'inge which fits accurately the papilla by 
means of a small funnel-shaped nozzle. When 
it is desired to catheterize the sub-maxillary duct 
the experimenter places himself in front of a 
mirror, with the mouth brilliantly illuminated and 
the tongue turned up against the roof of the 
mouth. The two papillae which mark the entrance 
of Wharton's duct will then be seen, one on each 
side of the fraenum linguae, the orifice of the duct 
being marked by a little dot upon their upper 
surface ; if now the flow of saliva be stimulated 
a canula may be inserted into the duct, but you 
observe, less readily than in the case of the 
parotid. This other specimen has been drawn 
off by means of a glass syringe. It is clear, 
more viscid than that of the parotid gland, 
and also alkaline. Its viscidity is, however, 
subject to variations ; when an acid stimulant is 
employed, a more fluid secretion is poured out 
than when a mechanical irritant is substituted. 

In man it also has the power of converting 
starch into sugar (experiment). In the dog this 
power is less than that of the mixed saliva, while 
it is entirely absent in that of the cat ; in fact, in 
all carnivora the diastatic action of saliva is 
feebly marked. 

The sub-lingual saliva has never been isolated 
in man, while in dogs it is doubtful whether the 
small glandular lobe which Bernard termed the 
sub-lingual is really a distinct, separate gland, or a 
lobe of the sub-maxillary ; it is true that it has 
a separate duct and furnishes a more viscid 
saliva. 

Before passing on to the study of the nervous 
system, I will take the opportunity of showing 
you an example of the elective excretory func- 
tions of glands. Among the various substances 
which can be introduced into the blood, some, 
as for example iodine, appear almost instantly in 
the saliva, while others, such as iron, do not 
enter it without the greatest difficulty. After 
chloroforming the rabbit, fastened on the Czer- 
mak's holder, in which you have seen me divide 
the parotid duct, I will expose the femoral vein 
and inject into it 1 cc. of a saturated solution of 
the iodide of potash, together with an equal 



amount of a 1 per cent, solution of the ferro-cyan- 
ide of potassium. The bleeding which resulted 
from the operation on the parotid duct has now 
ceased, and you see that acetic acid applied to 
the tongue causes the appearance of a drop of 
saliva in the wound. Now how can we recog- mk 
nize the presence of either of these salts in this ™ 
secretion ? Let us first look for the iodide. 
You remember that I showed you that the saliva 
prevented the coloration of starch by iodine, so, 
evidently, here we must employ some other re- 
agent. You also know, however, that this inter- 
ference was due to the oxidation of the iodine by 
the saliva ; so if we can overcome that result the 
test will succeed. I have here a piece of filter 
paper soaked in starch mucilage ; I place it over 
the wound so as to come in contact with the drop 
of saliva, but there is no blue color found. I 
will let fall a drop of nitrous acid on the paper, 
and instantly there is a decided blue, showing 
the iodine has been eliminated in the saliva, 
probably in the form of hydriodic acid, and when 
deoxydized by the nitrous acid, as free iodine, 
colors the starch. Now let us look for the ferro- 
cyanide. The test for its presence is its forma- 
tion of Prussian blue with a persalt of iron. I 
will place a piece of paper moistened with a 10 
per cent, solution of the perchloride of iron on 
the wound, but there is no coloration. 

Let us now look to the urine. Urine can 
be readily collected from rabbits b}' holding them 
over a large beaker, compressing the abdomen 
with one hand, and with the thumb of the other 
pressing the bladder well down into the pelvis. 
The urine is thus forced out and may be col- 
lected. I will now test a few drops of the fluid 
thus obtained, with the 10 per cent, solution of 
the chloride of iron, and there is a dense blue 
formed. It, however, gives no reaction with the 
nitrous acid and starch mucilage. Another very 
pretty way of showing that the iodine has been 
eliminated by the salivary glands and the ferro- 
cyanide by the kidneys, is to kill the rabbit by 
puncturing the medulla through the occipito- 
atloid membrane. I will now dissect out the 
parotid and sub-maxillary glands, and place them 
in the starch mucilage with the nitrous acid. 
The gland becomes bright blue. I will now 
remove one kidney, divide it through the hilum, 
and place it in a solution of the perchloride of 
iron, and Prussian blue is developed immediately 
in its gland substance, and on its surface. You 
have thus seen in a marked light the elective 
eliminative power of the salivary glands for 
iodine, while the kidneys excrete with especial 
facility the ferrocyanide of potash. 



Feb. 8, 1879.] 



Communications. 



"5 



Bernard, however, who was the first to remark 
this fact, has shown that the salivary glands will 
excrete iron when combined with iodine, as the 
iodide of iron, and when a local plethora, so to 
•speak, is created in the salivary glands by inject- 
ing the prussiate of potash into the carotid artery, 
we can then find it in the saliva. Another re- 
markable fact in this connection is that if a quan- 
tity of iodide of potassium be given to a dog, 
traces of it may be found in the saliva, sometimes 
for weeks ; the iodide is swallowed and then ex- 
creted in the saliva, which being swallowed again 
gives up the iodine to be absorbed, and again 
excreted, and so on. Absorption by the salivary 
glands is also possible, and sometimes occurs 
with great rapidity, if a solution of iodide of 
potassium be injected into the parotid duct of 
one side, it is almost immediately eliminated by 
the opposite gland. ' 



Communications. 



INVERSION OF THE HUMAN BLADDER. 

BY llEUBEN A. VANCE, M.D., 

Of Gallipolis, Ohio. 

( Concluded from, page 94. ) 

The three cases following are abstracts which 
•embody the important facts relative to the three 
"instances of vesical inversion which Mr. Croft 
•embodied in his paper on that subject. 

Oase 3. — Dr. Murphy's Case, reported in the 
Liverpool Medical Gazette, and quoted in the 
London Medical Gazette^ 1833, page 525. 

" Jane R., aged four years, admitted July, 9th, 
1829, into the Meath Infirmary. 

" Presented the following appearances on ad- 
mission : A pyriform tumor, the size of a small 
hen's egg, depending between the upper portion of 
the labia pudenda, of the color of dark mahogany, 
the base below, apex above ; the little finger in 
rectum communicated no motion to tumor, nor 
-could anything unnatural be detected. On 
raising the tumor toward the pubis, the vagina 
was seen, but the meatus urinarius could not be 
traced. The orifices of the ureters were not dis- 
covered until a very slight traction of the tumor 
downward rendered the inversion complete. 
A small silver probe passed up each orifice, on 
being withdrawn, was followed by urine almost 
devoid of smell or color. 

" Replacement. — The neck of the bladder was 
steadied by the thumb and fore-finger of the left 
hand, and the fundus having been pushed up- 
ward by the end of a gum-elastic catheter, its 



reinversion was easily effected. A catheter was 
retained thus for a few hours, by an assistant. 

' ' Some tenderness of the pubic region followed, 
attended by vomiting ; leeches, warm baths, and 
castor oil were prescribed. Those symptoms 
quickly vanished. Discharged, cured, July 17th, 
(eight days)." 

Case 4. — Mr. Crosse's Case, reported in the 
Transactions of the Provincial Medical and 
Surgical Associafio7i, N. S., 1846, page 185. 
Mr. J. Green Crosse was Senior Surgeon to 
the Norfolk and Norwich Llospital. 

"In the year 1829 a highly respected colleague 
of mine, since deceased, received under his care 
a healthy-looking female child, aged between two 
and three years, on account of a tumor about 
the size and shape of a walnut, projecting visibly 
at the external labia pudenda. It was of a florid 
red color, and somewhat granulated on its sur- 
face, so as to resemble a large strawberry 5 and 
the svirgeon entertained a notion that it was a 
vascular tumor, which might be removed by 
ligature, on which account he requested me to 
inspect it. After examination, I expressed my 
doubts as to its being a vascular tumor, and dis- 
suaded him from applying a ligature. Toward 
the postea-ior part of the tumor, on its sacral 
aspect, was an aperture conjectured to be the 
urethral orifice. A very small female catheter 
easily entered this aperture, and passed along a 
channel a little to the left of the median line. 
Urine distilled in drops from the catheter ; there 
Avas no gush, although the instrument entered so 
far that we concluded it must have reached the 
bladder. Besides what oozed from the instru- 
ment — tinged with blood — there was an oozing 
of urine from another source, which was unex- 
plained until a second examination, a few days 
afterward, on my casually coming to the patient's 
bedside, just as the surgeon was prepared to 
apply a ligature to the neck of the tumor. I 
now found, concealed in a fold of the tumor, 
near the posterior junction of the labia, two ori- 
fices, not far asunder, from which urine oozed, 
and which were evidently the vesical terminations 
of the uretei'S. On pressing the tumor firmly, 
as if to reduce it, like a hernia, I found it yield, 
and pass gradually behind the symphysis pubis, 
and within the labia ; and under a continuance 
of the taxis it all retired, leaving the external 
parts in their proper shape and position. A 
passage remained, through which the tumor on 
retiring had taken its course ; which was actually 
the dilated urethra, into which I could, and did, 
introduce my little finger until it fairly entered 
the cavity of the displaced bladder, 



ii6 



Communications . 



[Vol. xL 



" History.— -li was stated that the tumor had 
existed for a considerable time, and had always 
been attended by stillicidium urinae ; also, that it 
had been once replaced, but had again descended 
shortly before coming under my observation. 
During the time it was under my notice no re- 
lapse took place. After an interval of sixteen 
years no relapse had occurred, but she was con- 
stantly troubled by incontinence. I accomplished 
reduction by returning first that part of the blad- 
der next to the urethra, and lastly the fundus." 

Case 5. — Dr. Lowe's Case, reported in the Lancet 
of March 8th, 1862. 

" M. A, H., aged 2\ years, fine, healthy, 
but very irritable child. Admitted in West 
Norfolk and Lynn Hospital, under Dr. John 
Lowe, Nov. 10, 1859. On examination a vascu- 
lar looking tumor, the size of a large walnut, was 
found projecting through the external labia. When 
the little patient cried the tumor became more 
injected and increased considerably in size ; at 
the same time a gush of urine took place. On 
closer inspection the mass was found to be seated 
at the orifice of the urethra. On making gentle 
pressure the tumor receded under the finger, 
and presently disappeared altogether within the 
urethra, and the forefinger could readily be 
passed into the bladder. I had, therefore, no 
difficulty in diagnosing an inversion of the blad- 
der. From the statement of the mother it ap- 
peared that the child had been subject to incon- 
tinence of urine from its birth, and that from 
the time it was two or three days old a small 
substance had been observed to protrude during 
a fit of crying or straining. Each effort of this 
kind was followed by a flow of urine, and the 
child's condition, from this cause, was truly piti- 
able. The thighs and labia were excoriated, and 
the latter, besides being swollen and indurated, 
were covered with numerous pustules. Until 
the age of two years the tumor had receded as 
soon as the straining ceased, but latterly it con- 
stantly protruded, more or less. Treatment by 
actual cautery. She was eleven months under 
treatment. Result, no relapse, but some degree 
of incontinence. 

The following interesting account of a case 
of vesical inversion in an adult is worthy of no- 
tice in connection with the foregoing. My ab- 
stract is from the notes made by a friend who 
was aware of my interest in these cases. 

Case 6. — Mr. Henry Johnston's Case of Inversion 
of the Urinary Bladder during Pregnancy, re- 
ported in the Dublin Hospital Gazette^ of April 
16th, 1860. 

^' On the evening of Sunday, Aug. 8th, 1859^ 



was called to see Mrs. M., aged 20, who was 
threatened with miscarriage. Found her suffer-^— 
ing from ''pains," and such an amount of tenes-Mi ] 
mus that she wanted to remain constantly on 
the night-chair. Was told there had been great 
hemorrhage, and that the ''waters" had dis- 
charged yesterday ; she was nine months mar- 
ried, and thought herself four months pregnant. 
There had been vesical irritability for weeks, but 
she did well until Friday, the 6th, when, after 
lifting a box, she felt great uneasiness in her 
back, attended with frequent and urgent desire 
to pass water. These symptoms grew more- 
urgent on Saturday ; she was unable to retain her 
urine, vomited freely, and was at ease only when on 
the night-chair. I there found her on my first 
visit : it was only after repeated urging that she 
went to bed. On attempting a vaginal examina- 
tion, she complained bitterly of the pain, and, 
grew so impatient that my attention was drawn 
to the hyperaesthetic state of the genital pas- 
sages. On visual inspection I found a soft, fluctu- 
ating tumor, the size of a pear, pyriform in 
shape, extending as far down as the os externum 
of the vagina, and feeling like a bag of mem- 
branes. My finger passed from the base along 
the narrow, neck-like portion of the tumor into 
a small, narrow cavity, which I considered was 
the dilated os uteri ; being also under the im- 
pression that the narrow, neck-like portion of the- 
tumor was the cord attached to the ovum. I 
followed up this cord into a cavity which I pre- 
sumed to be that of the uterus. My patient now 
insisted on being allowed again to remain on the 
night-chair, and complained of her inability to 
bear any further examination. Being under the 
impression that the uterus would expel its con- 
tents, and there being no hemorrhage, I gave 
some general directions and returned home. 
Called again the morning following (Monday) 
and found her in much the same state ; she slept 
none during the night ; pulse rapid and excited ; 
vomiting attacks recurring frequently. Patient 
unwilling to submit to examination. Adminis^ 
tered an anodyne and returned during the even- 
ing with a medical friend, Dr. Bryce, to whom I 
conimunicated my fears of miscarriage. Dr. 
Bryce examined the parts and discovered that 
he could pass his finger behind the tumor, into 
the vaginal canal, where he felt the os uteri still 
undilated. He was puzzled, and after suggesting 
that there might be a malformation, finally de- 
cided that the tumor was a vaginal vesicocele — 
a prolapsed bladder — and not a bag of mem- 
branes. This discovery of the vaginal canal and 
the OS uteri cast new light on. the case. I re- 



Feb. 8, 1879.] 



Communications, 



117 



examined the tumor and found that it would 
yield to gentle pressure, continuing which it re- 
tired upward through the cavity which I had 
supposed to be the os, into the cavity which I 
had supposed to be the uterus, but from which 
flowed a small quantity of urine. The true 
nature of the case now, for the first time, became 
manifest, and I saw that I had to deal with an 
inversion of the bladder, that the opening through 
which I returned the tumor was the "meatus 
urinarius," dilated to such a capacity as to ad- 
mit two fingers. An ocular inspection of the 
parts confirmed my diagnosis and satisfied Dr. 
Bryce as to the nature of the case. Immediate 
and decided relief followed the reposition of the 
inverted bladder : the vomiting ceased ; the 
pulse fell ; our patient's expression changed ; the 
pain in the back ceased ; the urgent symptoms of 
vesical irritation were relieved ; and sleep was 
speedily induced. Some hours subsequently I re- 
visited her ; there was no return of the inversion ; 
on the contrary, the bladder contained so much 
urine that I passed a catheter and relieved her of 
a quantity of bloody urine. An anodyne was 
administered and perfect quiet enjoined. On 
Tuesday she was quite easy, although she was 
still vpiding blood and mucus from the bladder 
and there was constant dribbling of urine. Under 
treatment these symptoms subsided, and when 
she passed from under my observation (Decem- 
ber 3d, 1859) she was free from any vesical un- 
easiness, and was looking forward to an early 
confinement." 

Mr. Johnson, the reporter of the following 
case, mentioned that the late Professor Simpson 
had called his attention to two cases of inversion 
of the bladder reported in Cruveilhier's " Patho- 
logical Anatomy." He also spoke of the case 
which Dr. Meigs relates in his work on "Dis- 
eases of Women," This was a case of inversion 
of the bladder in a little girl, three years of age, 
in which the nature of the "growth" was not 
recognized until all the preliminaries for an oper- 
ation to remove the tumor had been arranged. 

In glancing over the foregoing histories the 
attentive reader will note the complication which 
renders Mr. Croft's case diflferent from the 
others — the rupture of the bladder. Dr. Lowe 
reports that when his patient cried ^ ' the tumor 
became more injected, and increased consider- 
ably in size." A gush of urine likewise took 
place at the same time. In a note to Mr. Croft Dr. 
Lowe says that he is sure the fluid was urinous, 
and that it came from the ureter. In referring to 
his own case Mr. Croft says : "I cannot think the 
fluid which I have described as escaping in little 



Lewis's case was ejected in a fountain from either 
of the ureters, 1st, because during the projection 
and tension of the bladder those orifices must have 
been tightly closed ; 2d, because the spot at 
which the fluid leaped out bled at the time, and 
became clotted immediately after ; 3d, the rup- 
ture was situated above and in front, whereas the 
orifices of the ureters must have been behind and 
below. Now, Dr. Lowe states in his letter that 
he watched " the escape from the ureters, which 
were distinctly visible. ' ' If it did not come from 
either of the ureters, whence did it escape? It 
could not have come from the bladder, for that 
was already turned inside out. 

"With regard to the nature of the fluid: had 
it been urinous, 1 think Mr, Stewart would not 
have failed to find evidence of its being so, either 
chemically or microscopically. I thought at the 
time, and I see no reason to change my opinion, 
that the fluid was serous, and came from the 
peritoneal cavity. I think the bladder, in becom- 
ing inverted through the urethra and meatus, 
carried its partial peritoneal coat with it. That 
being the case, a hernia of the peritoneum was 
formed, a hernia through the urethra and meatus. 
I think this sac became constricted by the meatus^ 
just as an inguinal hernia suffers constriction by 
the internal abdominal ring; the ['peritoneum, 
under these circumstances, Ipoured out, as it 
would do in an inguinal hermia, serous fluid, and 
that fluid gradually distended the pouch. Vio- 
lent expulsive efforts of the abdominal muscles: 
at last caused the rupture which I witnessed." 

Mr. Croft very truly says that the after absence . 
of peritonitis militates but little against the oc- 
currence of rupture of the bladder — neither does 
it invalidate the theory that the peritoneum had 
been herniated, and the fluid serous. That indi- 
viduals may recover from vesical rupture, per se, 
we all know. Death, when due to this accident, 
is always owing to secondary implication of the 
peritoneal cavity, from urinary extravasation. In 
Mr. Croft's case the vesical wound was small, 
the urine flowed freely away, and there were no- 
evidences of secondary implication of any portion 
of the peritoneal cavity. Under such circum- 
stances it would be surprising had not recovery 
ensued with great rapidity. 

If the reader will but review the history of 
those of the preceding cases in which the bladder 
was inverted in infants and children, he will find 
that the following are the symptoms which should 
lead the practitioner to diagnosticate an inversio 
vesicce, and to distinguish such an affection from 
a solid polypoid growth: — 

A tumor from the anterior portion of the os- 



ii8 



Hospital Reports. 



[Vol. xl. 



tium vaginae situated beneath the clitoris and 
between the labia, -which is pear-shaped, red, vas- 
cular and elastic ; the urethra not apparent, but 
both ureters may be distinguishable, and a pro- 
longed inspection will show that they distill urine ; 
and a history of urinary incontinence preceding 
as well as accompanying the advent of the 
tumor. 

The presence of the foregoing symptoms should 
cause the practitioner to repeat his examination, 
and subject his patient to a prolonged observation, 
before diagnosticating any other affection. A phy- 
sical exploration will generally suffice for diagnos- 
i;ic purposes, in the majority of cases. In fact, 
when once the surgeon has had his attention 
drawn to the existence of this rare lesion there 
is but little danger to be apprehended — it is only 
in cases where the observer has no knowledge of 
this condition, that harm may come from a hasty 
operation. When the writer remembers how 
narrowly his own patient escaped having a liga- 
ture thrown around its bladder, he may be ex- 
cused for believing that others may be similarly 
deceived. A knowledge of the possible exist- 
ence of this lesion will prevent any one from 
occupying the embarrassing position in which he 
was then placed, and if this paper succeeds in dif- 
fusing an acquaintance with the fact that the 
human bladder may become turned inside out, the 
writer will be amply repaid for his trouble in its 
preparation. 



Hospital Reports, 
philadelphia hospital. 

SURGICAL CLINIC OF DR JOHN H. BRINTON. 

REPORTED BY DR. W. M. ANGNEY. 

Frostbite. 

Gentlemen :-The extremely cold weather which 
has prevailed during the last few days affords me 
an opportunity of bringing before you two or three 
well-marked cases of frostbite. You have all 
doubtless been made familiar, by narrative, with 
the general constitutional effects resulting from 
prolonged exposure to a low temperature; of the 
benumbing effect produced upon the senses, and 
the desire to sleep, which once yielded to, may 
prove the sleep which knows no waking. The 
history of arctic exploration and mountain travel 
abounds with these accounts. The effect of ex- 
treme cold upon the living tissues is, to produce at 
first a sense of numbness in the part, accompanied 
by a shrinking of the tissues. The circulation 
through the capillaries is interfered with, and 
recession of blood from the surface to the deeper 
structures results. Hence it is, that where the 
whole body is exposed for any length of time to 
^old, as in the cases above referred to, accumula- 



tions of blood occur in the central organs, es- 
pecially in the brain and lungs, and coma and 
fatal sleep take place. 

The influence of extreme and protracted cold 
upon parts locally exposed is felt precisely in the 
same way. The blood is driven from the part ; it 
shrivels, shrinks, changes color, and loss of sensa- 
tion and motion occurs. You have seen me, over 
and over again, apply an Esmarch'sbandage before 
operation, and you will doubtless remember the 
appearance of the part when the elastic roller is 
unwound. The extremity looks marble white, the 
blood has vanished from the finger ends, the rosy 
tint dependent upon the circulation has fled, the 
temperature is reduced. The same phenomena 
are observable when the fatal death-chill creeps 
upward upon one who is moribund, and the icy 
hands and feet foretell too plainly approaching 
dissolution. These conditions are analogous to 
the effects of local cold ; the causes may be differ- 
ent, but the results are not unlike, and depend 
upon the withdrawal of the blood from the pe- 
ripheral tissues. Such is the first local effect of 
cold, it lessens the vitality of the part; let the 
depressing effect of the cold continue, and the 
part dies. Here again you can trace the analogy 
of an Esmarch's application. Harmless in the 
surgeon's hands, for a brief application, it also, 
if too long continued, may produce disastrous 
consequences : but of this I have already spoken 
to you more than once. 

From these brief words, and Avith this idea of 
the pathology of gelatio or congelation, in your 
mind, you can readily imagine the course and 
conduct of a frostbite. Take a minor degree of 
frostbite. The part is not altogether frozen ; it is 
not destroyed ; its vitality is simply lessened. 
What will be the result? reaction — a return of 
the circulation in the tissues, to a degree greater 
than normal. In other words, the depression is 
followed by inflammation ; the whiteness or lividity 
vanishes, and is succeeded by a fiery red, and the 
numbness gives way to a tingling or burning heat. 
And just here is the danger ; the inflammation 
may run too high, and result in the death of the 
part — gangrene. The surgeon's efforts must be 
directed to limiting and controlling this reaction, 
to keeping it within proper bounds, thus prevent- 
ing the final destruction of the parts. 

But the local effects of cold may not be limited 
to a temporary lowering of the vitality of a part. 
It may go further, and entirely destroy it ; despite 
the best endeavors no reaction may occur in the 
part ; it is mortified and dead. When such is the 
case, the substance of the frozen extremity grad- 
ually shrivels more and more, becomes dark, and 
eventually black, and the line of demarcation is 
developed between the living and the dead tissues. 
In one of the earlier sieges of our late war, where 
the men were greatly exposed, sleeping under 
the enemy's guns, without fires, and exposed to 
a drizzling sleet, I witnessed a number of such 
frostbites. Many of these occurred, if my memory 
serves me, from exposure during the night : and 
here let me say, that mortification, of the toes es- 
pecially, may result from a moderate degree of 
cold, if it be at the same time accompanied by ex- 
posure to wet. I have known it to occur in one 
case, when a wounded man slept with his feet 
projecting from under the tent cover ; the drip- 



Feb. 8, 1879.J 



Hospital Reports. 



119 



pings of the tent falling upon liis instep produced 
gangrene of both feet, much as if the agent had 
been great cold alone. As you would naturally 
suppose, the parts most apt to suffer from frost- 
bite are those which are most exposed, such as 
the ears and nose, the hands and toes. Pressure, 
such as that produced by a tight or ill-fitting boot, 
will also contribute to the same result. 

In the next place, gentlemen, let us consider 
the treatment of a frostbite. The indication is to 
bring about reaction, slowly and moderately, to 
increase the vitalitj'' and restore the circulation to 
a member which has been almost frozen ; and at 
the same time to do this so gently and gradually 
that the line of inflammation may not be reached. 
How is this thawing process to be effected ? I 
answer, hy means of cold frictions ; and by very 
carefully avoiding exposing the sufferer to too 
high a temperature, as to the direct heat of a 
fire. The patient should be treated in a cold 
room, and the parts should be rubbed with snow, 
pounded ice, or cloths dipped in cold water, and 
this should be kept up until the reaction is fully 
established. I would not employ stimulant or 
warm lotions, at all events, in the commence- 
ment of the treatment. If you should find that 
the effect of the cold is very persistent, you may, 
after using the cold rubbing, rub the parts with 
whisky, or some weak camphorated tincture, but 
it will be better for you to depend upon the cold 
applications as far as possible. If, when the re- 
action shall have been fully established, a tend- 
ency to slough in any portion of the integuments 
be manifested, the usual treatment in such cases 
becomes applicable. I generally employ cloths 
dipped in carbplated oils, and applications of 
that nature. When mortification is evident, no 
attempt should be made to remove the parts until 
the line of demarcation be fully established. 
Should an opposite course be pursued, and too 
early an amputation be resorted to, the result 
would most likely be sloughing or gangrene of 
the stumps. Festina lente must be your motto. 
Wait until Nature shall have clearly indicated 
to you her line of separation, and operate 
through it. 

From what has been said regarding the path- 
ology of frostbite, you would naturally expect that 
such cases would be most common in latitudes 
where the thermometer dips the lowest. This 
does not, however, appear to be altogether the 
case, for this affection would seem to depend 
somewhat upon changes and alterations of tem- 
perature, as well as upon the absolute degree of 
cold. As I have already intimated, cold com- 
bined with moisture, as when sleet and rain fol- 
low a cold snap, peculiarly dispose to the occur- 
rence of frostbite. Among the inhabitants of 
arctic regions frostbite undoubtedly occurs, but 
yet not as frequently as one might suppose, and 
I am told by a medical friend from Maine, who 
practices largely in a region where the thermo- 
meter often falls to between 30° and 40° below 
zero, that he has never seen there a case of frost- 
bite. We know very well that the debauchee, and 
those whose constitutions have been broken down 
by drunkenness, are most liable to the occurrence 
of the affection in question, and that its frequency 
is influenced by the character of the life of the 
individual. It may, therefore, be, that the strin- 



gent prohibitory law of Maine may serve to pro- 
tect her moral citizens against the rigors of her 
winters. 

From these remarks you Avill, I think, compre- 
hend the nature of the cases before you. This 
man has been walking in the snow, his feet being 
insufficiently shod. He tells us that they became 
very cold, and continiied to grow colder and 
colder, until they were quite benumbed. He 
afterward rubbed them until they became warm, 
and they then itched, and tingled, and burned him. 
The pain became so great that he could not walk, 
and he was then admitted to the hospital. No- 
tice, if you please, the condition of the parts, and 
the blackened tissues around the ankle, and 
along the sides of the feet. This patient has 
evidently suffered from a low grade of frost- 
bite, resulting in superficial gangrene. The 
limits of the gangrene are determined, the line 
of demarcation is being formed, and the slough 
is separating. Here is another patient with a 
like condition of the pulpy parts of the fingers of 
both hands. This man makes his living by sell- 
ing cakes in the streets, and he, too, has been, 
consequently, subjected to much exposure, and 
you know how cold the weather has been. The 
only treatment to be attempted in these cases is 
to favor the separation of the sloughs, let nature 
do her work, and then to remove with a scissors 
the dead parts. I shall direct these cases to be 
dressed with lint dipped in carbolated oil. If the 
sloughs were very extensive I might use char- 
coal poultices, but the oil dressings will answer 
very well here. 

Coxalgia. 

The next case is one of peculiar interest, inas- 
much as it is t3'pical of many you Avill meet with 
hereafter in your practice, and I am indebted to 
the courtesy of my colleague, Dr. Linn, for the 
opportunity of bringing the patient before you. 
I have not yet examined the case, and we will 
therefore study it together. This little girl is ten 
years of age. Some months ago she was noticed 
to limp in her walk, to drag or trail her foot after 
her, and to take less interest in playing than was 
her wont. In a little while she complained of 
slight pain in the inner side of the knee, on the 
front of the thigh, and over the knee. She 
"started in her sleep," to use the common ex- 
pression, complaining, at the time, of pain. The 
pains in the knee and thigh gradually increased, 
and she became unable to walk. She has 
been in the hospital five or six weeks. Look 
at her now, and notice the appearance of the 
thigh; it is flexed on the abdomen, adducted, or 
drawn inward, and apparently slightly shortened. 
When I attempt to rotate the thigh, she 
screams with pain, and so also when I extend 
the leg. I tap the knee slightly with the palm of 
my hand, and you hear her almost shriek with 
suffering. She refers the pain to the hip, and 
front of the thigh, and especially to the inside of 
the knee. When I place my hand broadwise on 
the buttock, around the upper part of the thigh, 
and in the neigh) )orhood of the joint, I find that 
the temperature is greater than natural, and this 
is very evident when, by my touch, I compare the 
temperature with that of the sound limb. I roll 
the child gently on to her sound side, and ask you 



I20 



Hospital Reports, 



[Vol. xL 



to observe the buttock of the diseased limb. You 
see that it is flatter than natural, apparently 
broader than its fellow, and that the crease be- 
tween the buttock and the thigh, thie gluteo-fem- 
oral crease, as it is called, is gone. On compari- 
son with the sound side, these conditions are very 
evident. 

I now replace her on her back, and employ 
a manoeuvre much insisted upon by Dr. Sayre. 
I take the sound limb, flex it on the abdomen, 
bring it suddenly straight, and the child does 
not flinch, or raise the pelvis from the bed. 
Let me do this with the limb of the diseased side, 
and watch the result. She has some pain as I 
carry this thigh upward, but when I attempt to 
bring it down suddenly, by extension, into a 
straight line, she throws her pelvis upward, and 
suffers so greatly, that, for humanity's sake, I must 
desist. Here, then, you have a characteristic train 
of symptoms. Limping, dragging the foot, pain 
at the knee and in the thigh, adduction of the 
thigh, apparent shortening, flattening of the but- 
tock, destruction of the gluteal crease, deepening 
of the lumbar depression, and the result in the 
extension test which I have just shown you. 
What does all this mean? Simply this. That 
this child is suff'ering from hip-joint disease in 
the second stage. In its fully developed phase, 
this affection is unmistakable, but in its very in- 
cipiency its diagnosis is at times difficult. On a 
correct diagnosis, however, the treatment must 
depend, and on the treatment the future of a 
child, for weal or for woe. I shall, therefore, ask 
your attention for a very few minutes to the sub- 
ject, and avoiding theoretical topics, which may 
be still suh judice, I shall examine this case from 
a practical clinical standpoint. 

Hip-joint disease, coxalgia, morbus- coxarius 
is a very common affection. It occurs in every 
class of life, among the rich as well as among 
the poor. By some surgeons, the essential ele- 
ment or predisposing cause of the disease is con- 
sidered to be a scrofulous tendency or diathesis ; 
others maintain that this dyscrasia is by no 
means essential to the occurrence of the affection, 
but that it may result from simple irritation. 
While I do not pretend to speak over positively 
on this subject, I must say that I incline to the 
former view, at all events, as far as the great ma- 
jority of cases is concerned. Be the cause what 
it may, the disease is unfortunately too often 
encountered. 

One classification of hip joint disease which 
you will find in the text books is based upon the 
starting point of the trouble, and the chief local- 
ity of the parts involved. Thus the femoral, ar- 
thritic, and acetabular varieties are spoken of; ac- 
cording as the inflammation begins at, or involves 
in the main, the head of the thigh bone, the liga- 
mentum teres and the softstructuresof the joint, or 
the acetabular cup. Coxalgia is also usually 
divided into three stages ; the first, when there 
is only a slight degree of limping or lameness, 
and little or no pain ; the second stage, when the 
inflammatory phenomena are well developed, as 
in the case before you ; and lastly, the third stage, 
when suppuration has taken place, and when 
abscesses have formed in and around the joint. 
In the interests of treatment it is all important 
that your diagnosis should be made early, and 



accurately, and that the proper rest treatment- 
should be promptly instituted. As Mr. Hilton has- 
well said, in his charming lectures on rest and: 
pain, if a child limps, the lameness must be due 
to some cause ; and if on examination the sur-: 
geon finds no evidence of disease in the foot,, 
ankle, or knee, the probability is that the trouble: 
is at the pelvis, or hip joint. 

The grouping of the symptoms at this stage of 
the examination is always important. First of 
all we have the increased temperature and the- 
pain. The latter is well explained by the nerve^ 
supply to the hip and its neighborhood. I will 
try and show you what this is. Here is a sketch 
on the blackboard, based_ on Hilton's outlines ; 
and we must thank this surgeon, or rather his- 
memory (for he has recently died), for the care 
and precision with which he has directed the at- 
tention of the profession to this matter. As you 
see in this diagram, the nerve supply to the hip 
joint is threefold. In the first place we have the 
obturator nerve, as it passes down the inside of 
the thigh, sending off a branch to the ligamentum 
teres, and to the capsular ligament. As you may 
remember, the terminal branches of the obtu- 
rator are spent upon the integument of the in- 
side of the knee and leg, a branch also being- 
given off to the synovial membrane of the knee. 
The second nerve to the hip joint, as stated, 
by Mr. Hilton, is a branch from the ante- 
rior crural to the front of the capsule ; the 
preripheral distribution of the anterior crural 
being to the skin of the front and inside of the 
thigh, and as far down as the inner side of the 
leg and foot, and also one or two articular- 
branches to the knee joint. The third nerve to 
the hip is a branch from the sacral plexus, aiL; 
articular filament to the back of the hip joint f: 
the remaining strands of the plexus being sent tO". 
the muscles and integument on the back of the. 
leg. 

In order to give due weight to the pain symp- 
toms in coxalgia, it is well to recollect this ner- 
vous distribution, for from it, it may not be im- 
possible to locate the point of pathological action. 
When pain exists on the inside of the knee joint,: 
as it most frequently does, the inference is fair that 
the form of coxalgia is arthritic or femoral in its 
character. On the other hand, the presence of 
pain in the posterior portion of the limb, or high 
up in the region of the buttock, would lead to the 
suspicion of a possible acetabular involvement. 
Perhaps it would be hazardous to base a diag- 
nosis on these phenomena alone ; yet at the same- 
time due weight should be given to them in form- 
ing the clinical judgment of a case. In the 
child upon the table, succussion upon the foot 
produces an acute darting pain, not only upon 
the inside of the knee, butalso on the integument, 
of the front and outer portions. I therefore am 
justified in believing that the morbid action in- 
volves the ligamentum teres, the soft structures^ 
of the joint, and also the head of the thigh bone,, 
and the capsular ligament in front. I find, also,. 
that pressure upon the trochanter causes pain, 
thus further substantiating the diagnosis of femo-^ 
ral as well as arthritic coxalgia. 

I will next draw your attention to the positiom 
or a,ttitude of the thigh of the diseased side. 
You observe that the thigh of this child is flexed: 



Feb. 8, 1879.] 



Hospital Reports, 



121 



upon the pelvis, and at the same time powerfully 
adducted. If you will make a ligamentous pre- 
paration of the hip joint, and then trephine 
the acetabular cavity from the inside of the pel- 
vis, you will have an excellent peep-hole to study 
the tension of the soft structures of the articula- 
tion. Here is such a preparation, and if you 
will examine it after lecture, you will find that 
flexion and adduction of the thigh relaxes and 
relieves all strain upon the ligamentum ^ teres 
and its associated soft parts. In this position of 
an inflamed hip joint the ligaments are put at 
rest, and consequently are freed from pain. 
Hence nature causes the limb to assume this 
attitude by the action of the psoas, iliacus, and 
the adductor muscles. The shortening of the limb, 
which was once regarded as a sympton of mor- 
bus coxarius, is probably fictitious. Ii, arises 
from the drawing up of the ilium of the diseased 
side, and the twisting or tilting of the pelvis to 
the opposite side. By this elevation and adduc- 
tion a patient, when standing, in the early stage 
of the disease, rests easily and comparatively 
painlessly, upon his toes, and at a later period 
of the affection, when confined to bed, sustains 
with his well foot the weight of the diseased limb, 
and guards and protects it from shock or succus- 
sion when moving in bed. I will now ask this 
little girl to move on her bed, and as she does so 
you can easily understand the phenomena I 
have just described to you. You can see how, 
with her healthy foot, she raises, and if I might use 
the expression, handles, that of the affected side. 

We have thus, I think, clearly made out that 
this poor little girl is, suffering from hip joint 
disease in the second stage. The pathognomonic 
symptoms are present, and I have endeavored to 
make them intelligible to you. To sum them up, 
she has pain on the front and inside of the thigh, 
and over the knee, increased on succussion. The 
thigh is flexed and adducted, the gluteo-femoral 
crease is effaced, the temperature of the joint is 
elevated. There is apparent shortening ; the 
limb does not respond to the extension test, and 
its attitude is characteristic. There is no doubt 
as to the nature of her trouble. What can we do 
for her ? I answer in one short sentence : " Put 
the parts at rest, complete and absolute rest." 
This is the first great indication to be observed. 
At the same time build up her constitution by 
general tonics, and by placing her in the very 
best hygienic conditions attainable under the 
circumstances. 

I shall, therefore, advise that this little one 
shall be fully etherized, and then that the 
limb shall be brought down straight, into 
the extended condition. An adhesive plaster 
extending strip should then be applied, as for 
fracture of the thigh, and extension should be 
kept up by a light weight, say a pound or two-, 
this weight to be increased or decreased as occa- 
sion may demand. By raising the foot of the bed 
the tendency of the patient to slip downwa,rd can be 
readily counteracted. From the nervousness of 
this little girl at the present moment, and the evi- 
dent irritation of the parts, you might suppose 
that such a dressing could not be endured. But 
experience teaches us to the contrary, and you 
will, I am sure, hereafter, be both sqrpfised and 
delighted at witnessing the relief afforded to a 



suffering child by such an application. In a very 
short time a little patient will be accustomed to 
this dressing, and will^be unwilling to have it in- 
terfered with or removed. A child learns very 
soon what is most comfortable for him, and with 
this apparatus well applied will remain quietly in 
bed, playing with his toys, or amusing himself 
with books, happy and contented. I can recall 
many such cases to my mind, where children con- 
fined to bed for hip disease have lost the ex- 
pression of anxiety and pain so characteristic of 
the malady, and have grown fat and almost rosy. 
The period during which it may be necessary to 
keep a child thus confined to bed varies greatly 
in different eases. 

The best rule, perhaps, is to keep on the extend- 
ing apparatus until the acute inflammatory symp- 
toms shall have passed away, and the irritability 
of the parts shall have subsided. An apparatus 
with the rack and pinion extension may then be 
adjusted, and the patient allowed to leave his 
bed ; or resort may be had to the plaster casing, 
applied by means ofa roller bandage. You will, 
of course, understand, that while this mechanical 
treatment is being carried out it is desirable to 
build up the patient's constitution in every way, 
by iron, and quinine, good diet, fresh air, and by 
such tonic and hygienic measures as may seem 
most appropriate to the individual case. 

I shall endeavor to bring this child before you 
at the expiration of a month from the present 
time, when you may have the opportunity of 
witnessing the result, and I trust it will be a 
favorable one, of the treatment which will l)e 
instituted in her case. 



* * -x- ■^- 



NEW^ YORK HOSPITAL. 

DISEASES OF THE SKIN. 
BY L. DUNCAN BULKLEY, M.D. 

Reported for the Medical and Surgical E-epoktke. 

Gentlemen: — In pursuance of the plan which 
I have laid down for this course, I will to-day, 
as usual, devote the first half of my hour to a 
somewhat rapid glance at the prominent charac- 
teristics and the most important points in the 
treatment of some of the cases which are pre- 
sented at the clinic ; reserving a more systematic 
and detailed consideration of the various affec- 
tions in question for the latter half, or didactic 
portion, of my lecture. 

Psoriasis. 

You remember this boy, who was before us 
last week, and who is suffering from well-marked 
general psoriasis. To-day I 2)ropose to com- 
mence a new treatment in his case, and in order 
to note what real effect it has here, I shall apply 
it to but a portion of the body at once. The 
agent which I am going to employ is chryso- 
phanic acid, which seems to be quite a marvel- 
ous remedy in many respects. It is well to 
notice, in the first place, however, the improve- 
ment which has already taken place in the eruption 
under the exclusively internal treatment which 
the patient has been using for the past three 
weeks. It has lost much of its red character, 
there are much fewer scales, and they come off 



122 



Hospital Reports. 



[Vol. xL 



much more readily. But when I scrape the sur- 
face of diseased tissue, even where there is not 
much scaling, those of you who are sufficiently 
near will perceive that we still find beneath the 
ordinary micaceous scales the little membrane 
or pellicle, entirely distinct from the scales, which 
slips off readily, leaving the characteristic bleed- 
ing corium of psoriasis. The evidences of im- 
provement may be briefly summed up as follows : — 

(1) Less congestion. 

(2) Borders of diseased patches less clearly 
defined. 

(3) Scales fewer and more easily detached. 
The patient will now be directed, every night 

and morning, to make active friction over the 
surface of the left arm only, with coarse soap 
and water, and then to rub in thoroughly an 
ointment containing the chrysophanic acid, half 
a drachm to the ounce. It may be used much 
stronger, even up to two drachms of the acid to 
an ounce of ointment, but I prefer beginning 
with a milder strength, as his skin is delicate, 
and I have seen very considerable inflammation 
excited by this agent. You will remember that 
this ointment is to be prepared by melting the 
excipient. and dissolving the chrysophanic acid 
in it, stirring until cold. In case it should give 
him much pain, however, the application need 
be made only once a day. In addition, he will 
continue to take internally, as before, the ace- 
tate of potassa, as I believe it to be one of the 
very best means at our command for relieving 
cutaneous congestion. 

The accounts of chrysophanic acid are that, 
of itself, it absolutely cures psoriasis. This 
statement has been made by reliable observers, 
who, in certain cases, have noticed no return of 
the disease for a year, or a year and a half, after 
the remedy was discontinued. Whether, in such 
cases, the eruption will finally return or not, 
there has not yet been sufficient time to deter- 
mine ; but I caution you against ever promising 
too much in psoriasis. At all events, it can cer- 
tainly be said with truth that more speedy results 
can be obtained by the use of this agent than 
from any other that has ever been tried. The 
only disadvantages connected with the employ- 
ment of chrysophanic acid are, that it sometimes 
causes considerable erythematous inflammation 
of the healthy skin, and that it stains the surface 
of a dark hue, and also stains the clothing badly ; 
but if in any case the patient can be persuaded 
to shut himself up for a week or so, in order to 
have the remedy thoroughly applied, the results 
are, indeed, wonderfully satisfactory, as I can 
abundantly testify. 

I now ask you, for a moment, to look at this 
other patient, a man of thirt3^-five, who is also 
suffering from psoriasis. While the eruption 
presents some diff'erences from that in the other 
case, you will observe the same micaceous scales, 
and, on scraping, the same little membrane and 
readily-bleeding corium beneath. On the back 
there is very nicely shown a variety of psoriasis 
known as gyraia^ in which the aff'ected spots 
have a margin covered with the white scales of 
the disease, with a healthy centre. 

Psoriasis in Stage of Decline. 

In thisAvoman you see a psoriasis which is now 



yielding nicely to treatment. Here the erup- 
tion has taken to a great extent the form of rings, 
or grouped papules ; so that in this respect it 
bears considerable resemblance to a syphilide. 
You know that, as a general rule, psoriasis, by 
preference, attacks the extensor surfaces, while 
eczema aff'ects the flexors, but in this case the 
latter are markedly the seat of the disorder. For- 
tunately, psoriasis usually spares the face ; but 
this case is also an exception to the general rule 
in this respect, and I want you, therefore, to ex- 
amine the disease very carefully here, as you rnay 
not have the opportunity of seeing another similar 
case. You perceive that the neck and face are 
each aff'ected on both sides, and that in this loca- 
tion the disease reseml)les eczema ; though in 
eczema you would not have these separate, cir- 
cular, red papules, nor would the margins be as 
well defined as here. The patient is now getting 
along very satisfactorily, and the eruption rapidly 
fading. 

Syphilitic Onychia. 

The next case I present to you is one of double 
syphilitic onychia ; in which you will observe 
that the man has lost the nails of both thumbs. 

When the patient was before us for the first 
time, two weeks ago, as some of you will remem- 
ber, there was suppuration going on beneath the 
nail, accompanied by a very fetid discharge, but 
without much inflammatory action. These are 
the ordinary characteristics of such an onychia, 
which is due in reality to a tubercular syphiloderm 
beneath the nail. Double symmetrical onychia, 
I may remark, is characteristic of syphilis, and 
is seldom, if ever, met with (unless under some 
very peculiar circumstances) except as a result 
of this disease. The patient is now on the mixed 
treatment, of mercury and iodide of potassium, 
and is doing ver}' well, the discharge, as well as 
the fetid odor, having ceased almost immediately 
after he was here last. No local treatment was 
employed at first; but we will now order him an 
ointment of the liquor ferri persulpTiatis (a 
drachm to the ounce), which you will find of 
great service in all forms of onychia. The con- 
stitutional treatment will, of course, be continued. 

Infantile Urticaria. 

Here are two young children suff'ering from 
urticaria, or nettle-rash, which is frequently an 
affection that gives a great deal of trouble i 
early life, and especially in cachectic children. 
In the first child, which is about eighteen months 
old, you perceive merely the results of scratch- 
ing and none of the characteristic wheals of the 
disorder; and this, you will find, is not infre- 
quently the case. You see here nearly the whole 
body, as well as the limbs, covered with scratch- 
marks, torn papules, and stains. 

In the second child, who is a year or so older, 
the same lesions are also found to be present; 
so that we might be led to suspect some com- 
mon cause of the trouble, such as a parasitic dis- 
ease. But here, if we examine the buttocks 
carefully, we can make out some of the wheals 
characteristic of urticaria; and this at once 
points us to the correct diagnosis. Now there 
are but three or four diseases which could give 
rise to such a condition as you see in these 
children ; scabies, phthiriasis, eczema and pa- 



Feb. 8, 1879.] 



Periscope. 



123 



pular urticaria. The absence of any marked 
eruption on the hands and feet, together with the 
absence of the caniculi or furrows, excludes 
scabies ; phthiriasis corporis (body-lice) very 
rarely, if ever, affects children so severely as 
this, nor would you find the legs and arms thus 
scratched in that condition; and, finally, the 
papules are too isolated for eczema, while at no 
place has the scratching given rise to such lesions 
as we would be certain to find in that disease. 

In children urticaria frequently takes this 
papular form, and this feature has given rise to a 
name by which it is frequently, though wrongly, 
known in England, namely, lichen urticatus. In 
regard to the treatment, we must look carefully 
to the digestive system of the child, regulate the 
diet, and give such remedies as will be most 
likely to correct any disorder in the alimentary 
tract. I know of nothing more generally useful 
in this connection than acetate of potassa, given 
in a mixture of rhubarb and soda. Locally, car- 
bolic acid with caustic potash, in solution, will 
give very great relief; the formula I use being as 
follows : — 

R. Acid, carbolici, 5J 

Potassae causticge, ,5 ss 

Aquae, f. % iv. M. 

The ingredients to be well rubbed together. 
This may, of course, be diluted if it burns the 
skin. 

Syphilitic Bursitis. 

This woman is an old syphilitic patient of 
mine, who has neglected treatment for a long 
time, and who now comes back with some small 
tubercles, of a purplish red, and characteristi- 
cally grouped together, about the knee, and also 
what I believe to be a syphilitic inflammation of 
the bursa patellce. The bursa, you perceive, is 



very much enlarged, as in " housemaid's knee," 
but the latter affection is usually double, while 
these latter manifestations of syphilis are apt to 
be one-sided. Such a grouped tubercular 
syphilide as you here see (in addition to the 
bursal trouble) is not uncommon ; and the 
region of the knee is quite a favorite seat for it. 
General Papular Syphilide. 
Again, I show you the same girl, with early 
constitutional syphilis, who was presented to you 
last week and the week previous. She comes 
back to-day principally on account of a specific 
iritis, which has recently developed itself In 
connection with this case, I should like to call your 
attention to the fact that it is rare to find a papular 
or pustular eruption as the first general lesion of 
syphilis in women ; why, I do not know, but the 
macular syphilide is almost always observed in 
them, whereas this form of syphilis almost al- 
ways manifests itself in the opposite sex. As a 
curious corroboration of this, i believe that every 
plate of a papular and pustular early syphilo- 
derm that I have is taken from a male subject, 
while almost all the pictures of macular syphilo- 
derm represent females. It may be that this 
tendency on the part of females to have this very 
superficial erythematous rash accounts for the 
fact that it is often so difficult to trace a history 
of syphilis in them, for I have repeatedly seen 
it when it had been quite itnnoticed by the pa- 
tient. But you can hardly imagine that this 
woman will not bear a vivid recollection of this 
rash for a long time, nor will she be apt to for- 
get this iritis, which causes her so much distress. 
You should not neglect to observe the grouped 
circular arrangement of the papulo-pustules of 
the eruption, and also the enlargement of the 
post-cervical glands, which is quite marked here. 
(To be Continued.) 



Editorial Department. 



Periscope, 



Chronic Intermittent Albuminuria of Adolescents. 

An important affection of the kidneys has, in a 
recent paper, been named by Dr. Moxon (" Guy' s 
Hospital Reports,'''' third series, vol. xxiii, page 
233) chronic intermittent albuminuria of adoles- 
cents. It occurs in young men, generally between 
the ages of fifteen or sixteen and twenty-two years, 
and is characterized by the appearance of albumen 
in the urine at one time and not at another, but 
generally in the urine passed after breakfast. The 
first urine passed in the morning, as well as the 
afternoon urine, may be completely free, though 
in some cases albumen is only found in the even- 
ing. Dr. Moxon has met with more than twenty 
such cases of intermittent albuminuria all an- 



swering to the above description, and (most im- 
portant of all) he has seen several of them com- 
pletely recover. Examination of the various 
systems of the body gives negative results, but 
patients are generally brought to the doctor by 
their friends, on account of their languor and 
general indisposition to exertion and to joining 
in the common amusements of society. Dr. 
Moxon appends a note from Sir William Gull, 
in reference to one of his cases, in which he 
mentions that he has himself so often found al- 
bumen in the otherwise normal urine of youtbs 
from sixteen to twenty-two, that he regards the 
affection as common, and attributes it to '' atony 
of vessels and nerves.'" Dr. Moxon, however, 
thinks it possible, from the large quantity of ox- 
alate of lime which is usually present in these 
cases, " that morbid matters in the urine itself 
may induce an active irritation of the kidneys," 



124 



Periscope. 



[Vol. xl. 



and also that disturbances of the sexual system 
at this period of life " might be allowed as likely 
to reflect disturbances to the urinary system." 



On Antecurvature of the Uterus. 

At a late meeting of the Obstetrical Society 
of London, a paper was read by Dr. George 
Boper, entitled ''Some Clinical Remarks on a 
certain class of cases of Anteflexion of the 
Uterus, with certain correlated conditions." 
The object of the paper was to describe and dif- 
ferentiate a special class of cases of anteflexion 
of the uterus. In these cases the abnormal shape 
of the uterus was a congenital malformation, 
and was not either an effect or a cause of patho- 
logical change in its texture. The axis of the 
organ was a curve, with the concavity forward ; it 
was not bent at an angle at any one point. There 
was no softening of the tissues, but on the contrary, 
rather rigidity, for the organ could not be easily 
straightened. This condition was often associ- 
ated with deformity of the cervix and stenosis of 
the external os and canal. To distinguish this 
malformation from other kinds of anteflexion, 
the author proposed to call it '' antecurvature " 
of the uterus. He believed this antecurvature 
was much commoner than any other kind of ante- 
flexion, and that, in the unmarried especially, it 
caused no symptoms beyond those of dysmen- 
orrhoea. He had noticed other kinds of devel- 
opmental peculiarities, one or more of which 
generally coexisted with this malformation. 
These were (1) a short conical vagina, (2) a 
narrow perineum, (3) a conical distribution of 
the pubic hair, long hairs on the mammary 
areolae, and an unusual amount of hair on the 
legs and forearms. The deformity of the uterus 
often gave rise to dysmenorrhoea, from the canal 
being curved and narrow. The treatment of this 
was then considered. The author thought in- 
cision of the vaginal portion advisable when the 
cervix was much hooked. Incision of the cervix 
up to and through the internal os, sudden dila- 
tation of the cervix by expanding sounds, or the 
use of tents, or intra-uterine stems, or of vaginal 
anteflexion pessaries, he considered either ineffi- 
cient or unsafe, and therefore, objectionable. 
He had obtained excellent results from gradual 
dilatation of the cervical canal with metallic 
bougies ; he believed this treatment to be quite 
free from risk, and therefore preferred it. There 
was^ also in these cases a condition of sexual 
nullity ;_ sexual desire was absent; in many cases 
sexual intercourse was painful, and there was 
often vaginismus. He thought the co-existence 
of these conditions was not accidental, but that 
they were part of a general developmental defect. 
The pelvis, too, he thought, partook somewhat 
of the male type. 



I he Use of the Forceps when the Os Uteri is Par- 
tially Dilated. 

^ At a recent meeting of the Dublin Obstetrical 
Society, Dr. George Johnston, ex-Master of the 
Rotunda Lying-in Hospital, read an interesting 
paper on the use of the Forceps in that institu- 
tion from 1808 to 1875. Omitting all refer- 



ence to that portion of the paper in which the 
use of the forceps in ordinary cases is discussed, 
we would draw attention to those cases in which 
they were used before the os uteri was fully 
dilated. The forceps were applied in 59 cases, 
44 of which were primiparse, where the os uteri 
was two-fifths of its normal dilatation, the j)rinci- 
pal causes of interference being early rupture of 
the membranes (42 cases), pressure on anterior 
lip of uterus (8), prolapse of funis (2), and con- 
vulsions (2). In 18 the head was above the brim, 
in 17 in the brim, and in 24 in the cavity. Of 
the 59 children, 48 lived, 9 were born dead, and 
two died ; and of the mothers, 53 recovered and 
6 died. In the second division, where the os 
was three-fifths dilated, there occurred 71 
cases, 53 being primiparas, the operation being 
due in 43 instances to early rupture of the mem- 
branes, and in 13 cases to pressure on the ante- 
rior lip ; the forceps were applied in 6 above the 
brim, in 36 in the brim, and in the cavity 29 
times respectively, with the result that 58 chil- 
dren lived, 7 being born dead, and 6 died ; while 
of the mothers, 2 succumbed, one from gastro- 
enteritis, and the other from uterine diphtheria. 
Where the os uteri was four-fifths dilated, 39 
cases occurred, 26 being primiparae, with a result 
of 9 deaths to the children, and one death, a pri- 
mipara, due to convulsions. Dr. Johnston has 
long been an advocate for using the forceps in 
cases of a similar kind, and he states that the re- 
sults generally are very satisfactory ; but remarks 
that the forceps should not be used under similar 
circumstances, except by a practitioner who is 
thoroughly acquainted with the process of partu- 
rition, and has also obtained the necessary deli- 
cacy of touch and accuracy of manipulation. 



The Action of Large Doses of Capsicum. 

The Archiv filr Pathologic gives some research- 
es of Hogyes showing that the action of capsicum 
in considerable doses is less poisonous than some 
authorities have asserted. It has been said to 
cause, when applied to the skin, redness, vesica- 
tion, and ulceration ; and when taken by the 
mouth, vomiting, inflammation, and painful diar- 
rhoea. Landerer and Tresch assert that its active 
principle is capable of causing death. Hog.yes, 
however, found little evidence of action except 
upon the sensory nerves, with more or less reflex 
hypersemia of transient duration, and no perma- 
nent anatomical change. It increases the secre- 
tion of saliva and of the gastric juice, and favors 
the peristaltic action of the intestines, and so pro- 
motes digestion. Fifty grammes of powdered 
capsicum caused a dog to vomit twice, perhaps 
on account of the bulk of the dose, but it was 
quickly better. The same dog did not vomit after 
two cubic centimeters of capsicol, corresponding 
to two hundred grammes of the powder. Capsi- 
col bites the tongue sharply, but applied to the 
conjunctiva causes only a trifling redness. 

It was once thought that capsicum might furnish 
a substitute for quinine, because brandy, to which 
it has been added, is a reputed prophylactic 
against intermittent fever. The results of experi- 
ment do not, however, warrant any expectation 
of an anti-febrile action. 



Feb. 8, 1879.] Reviews and Book Notices, 



125 



Reviews and Book Notices, 
notes on current medical 

LITERATURE. 

A journal, to be called "'■ The Archives of 

Medicine," is announced by G. P. Putnam's 
Sons, to be issued in February. It will be edited 
by Dr. E. C. Seguin. 

In a reprint from the Maryland Medical 

Journal, Dr. S. Theobald discusses the skepti- 
cism prevalent regarding the efficacy of aural 
therapeutics, and argues that is far from justi- 
fiable. 

The St. Louis Courier of Medicine is a 

late venture in the journalistic field. It is pub- 
lished monthly, by the Missouri Medical Journal 
Association. Its special field is to be in the pro- 
fession in Missouri. The first number presents 
a handsome appearance, and has a number of 
good articles. $3.00 per year. 

With the close of last year the English 

medical journals The Doctor and the Medical 
Examiner ceased publication. There now re- 
main in the field but four old-established week- 
lies : The Lancet, Medical Press, British Medical 
Journal and Medical Times, with a few monthly 
journals, and one or two quarterlies on special 
subjects. 

Dr. James Rush's once popular treatise 

on the Philosophy of the Human Voice has long 
been out of print, and the publishers have de- 
cided to issue a new edition. The work was, in 
its day, the best then published on the subject ; 
it embraces the Physiological History of the 
Human Voice, together with a System of Princi- 
ples by which criticism on the art of elocution 
may be rendered intelligible, and instruction 
definite and comprehensive. Of course, much of 
it is now antiquated. 



BOOK NOTICES. 

Medical Chemistry, including the Outlines of Or- 
ganic and Physiological Chemistry. By C. Gil- 
bert Wheeler, Professor of Chemistry, in the 
University of Chicago. Philadelphia, Lindsay 
& Blakiston. Chicago, S. J. Wheeler. 8vo, 
pp. 424. Price $3.00. 

The author, believing that medical chemistry 
as such has not received the attention from writers 
in this country which it requires, has prepared a 
manual adapted especially to students who have 
already familiarized themselves with inorganic 



chemistry and the general principles of chemical 
philosophy. Hence he passes by these prelimi- 
nary studies, and divides his work into two parts 
— Organic Chemistry and Animal Chemistry. 
The first, he states, is mainly a translation from 
Wicho,'' B, Manuel de Chimie; the second is more 
an original compilation. In it he takes up the 
various fluids and tissues of the body, its nitro- 
genous substances, the saliva, gastric juice, in- 
testinal fluids, bile, blood, urine, etc., one after 
another, giving their constituents, reactions, 
chemical pathology, etc. 

Throughout the work prominent and recent 
authorities are quoted, and judging from the 
articles we have particularly examined, we should 
say that a very fair summary of the latest and 
most reliable information is given. As the 
author justly observes in his preface, the diffi- 
culty in such a work is not from the scantiness, 
but from the abundance of the material, and 
hardly two chemists will agree on what can best 
be omitted. In this respect the author appears 
to us to have exercised good judgment. 

An Atlas of Human Anatomy. Illustrating most of 

the ordinary Dissections and many not usually 
practiced by the student. Accompanied by an 
Explanatory Text. By Rickman John Godlee, 
M.S., F.R.O.S., etc. Philadelphia, Lindsay & 
Blakiston. Part i. Price $2.50. 
This is the first number of an atlas in large 
quarto, with colored plates, four in a number, to 
be completed in twelve or thirteen bimonthly 
parts. Each plate is faced by a page of refer- 
ences, and each part is to be accompanied by an 
octavo part containing the explanatory text. 
When completed the work will form a large folio 
volume of plates and references, and an octavo 
volume of 300 or 400 pages. 

The author, Mr. Godlee, enjoys an excellent 
reputation in London, as a profound anatomist, a 
skillful teacher, and an expert artist. The plates 
in the number before us testify thoroughly to his 
last mentioned qualifications. They are very 
neatly drawn and colored, and will certainly ren- 
der the study of regional anatomy easy and attract- 
ive. The plates show dissections of the head and 
neck, and it has been the design of the author to 
exhibit dissections not usually demonstrated, in 
order to enable the student to understand the 
mutual relation of parts which otherwise he is 
apt to regard as separate and independent. 

The general character of the work is excellent, 
and no doubt it will achieve considerable popu- 
larity among students of anatomy. 



126 



Editorial. 



[Vol. xl. 



THE 



Medical and Surgical Reporter, 

A WEEKLY JOURNAL, 

Issued every Saturday. 



D. G. BRINTON, m.d., Editor. 



The terms of subscription to the serial 'publi- 
cations of this office are as follows, payable in 
advance : — 

Med. and Surg. Reporter (weekly), a year, $5.00 
Half- Yearly Compendium of Med. Science, 2.50 

Reporter and Compendium, - - . 7.00 

Physician's Daily Pocket Record, - - 1.50 

Reporter and Pocket Record, - - - 6.25 

Reporter, Comp. and Pocket Record, - - 8.25 

For advertising terms address the office. 

Marriages, Deaths, and Personals are inserted 
free of charge. 

All letters should be addressed, and all checks 
and postal orders drawn to order of 
D. Gr. Brinton, m.d,, 

115 South Seventh Street, 

Philadelphia, Pa. 

THE THEORIES OF EPIDEMIOLOGY. 

The theory of epidemic diseases continues very 
incomplete. We are not very much ahead of 
the ' ' epidemic constitution of the air ' ' of Syden- 
ham, although our more modern views incline to 
reduce the contagium of epidemics to fungi, 
bacteria, or other low forms of vegetable or ani- 
mal life. 

Another theory which crops out from time to 
time, is the cosmical or planetary origin of epi- 
demics. A clipping has been going the rounds 
of the papers lately, to the effect that in 1881 we 
enter upon a peculiarly maleficent period of 
planetary and stellar arrangements, which will 
last six years or so, and give the doctors plenty 
to do. A few years since we remember a long 
and learned article in the New York Medical 
Journal, defending this hypothesis. 

Yet another doctrine is that of the telluric origin 
of epidemics. Emanations of some kind from 
the soil are supposed to excite them. This is 
somewhat allied to Pettenkofer's teachings about 
the "ground-air" and the "ground-'^ater." A 



Parisian physician of eminence, Dr. Besnier, 
has urged this thing in a recent paper read before 
the Society of Parisian Hospitals. 

"I have iiever been wearied," Dr. Besnier 
observes, "for a great number of years, in show- 
ing by facts that general hygiene and the pro- 
phylaxis of popular diseases can only be based 
with certitude upon a thorough knowledge of 
the laws of epidemiology, until lately completely 
ignored. It is in this direction that I have some- 
what superabundantly demonstrated that there 
are really benign medical constitutions and ma- 
lignant constitutions, determined by telluric con- 
ditions, which, although still obscure, are not 
doubtfal as to their reality. Overcrowding, 
change of climate, bad hygienic conditions, ex- 
posure to contagion, misery, etc. — in a word, all 
the traditional and classic conditions of the gene- 
ration and development of these diseases — only 
occupy on the general etiological plane an infi- 
nitely lower level. The public health, as well 
as the condition of the atmosphere, is subjected to 
variations. Some of these are fixed and unchange- 
able — viz, the seasonary variations, upon which 
the hygienist physician may found his previsions 
and general prophylactic measures may be regu- 
lated beforehand. Others are irregular, at all 
events in appearance, but which we are even now 
able, under certain circumstances, to foresee and 
announce, just as we are commencing to be able 
to scientifically announce the cause of storms. 
It is these latter conditions, and not the con- 
tingent traditional conditions of ordinary hygiene, 
which determine and regulate the great oscilla- 
tions of epidemic diseases. Although these propo- 
sitions have at the present time, in presence of the 
observations which we are continually accumulat- 
ing and classifying in these reports, become truths 
relying upon evidence, they are far from being 
known or appreciated according to their value 
by medical opinion diverted into other channels, 
perhaps rich for the future, but certainly less 
fertile in immediate applications to the usefiil 
and practical knowledge of popular diseases." 

What looks like a curious corroboration of this 
view is contained in a description of the late epi- 
demic of the plague in India, written by Dr. 
David Manson, of Amoy. He observes one fact 
which inclines .one to think that the epidemic is 
owing to exhalations from the soil, and it is this: 
those animals that live in the ground, in drains 
or in holes, are those first to be attacked. This 
is particularly noticeable with the rats. As soon 
as these animals are ill, they leave their holes in 
troops, and after staggering about and falling 
over each other, drop down dead. The same 
phenomenon occurs in the case of other animals, 
such as buffaloes, oxen, sheep, deer, pigs, and 
dogs. All are attacked, but the dogs less severe-^ 
ly than the others. 



Feb. 8, 1879.] 



Notes and Comments. 



127 



" When tliese phenomena appear, it is not long 
before the disease spreads to man ; and knowing 
this, the people take every precaution to guard 
themselves from the plague. They begin to 
purify their houses by lighting fires in every room, 
and in certain towns they abstain from pork. In 
man the disease commences with a slight fever, 
which rapidly increases, and in a few hours be- 
comes very violent. The patient clamors for 
drink, and his thirst is insatiable. By-and-by a 
dark red swelling shows itself in the armpits, 
groins, or neck, and the fever continuing to aug- 
ment, the patient becomes rapidly unconscious. 
The bubo increases until the second day, after 
which it remains stationary, and when it has at- 
tained its full size it is about as large as a hen's 
or goose's egg. At this stage consciousness re- 
turns, but there is still great danger, for if the 
swelling, which up to this point is very hard, be- 
comes soft, and if the fever still continues, the 
case is considered hopeless. On the contrary, 
if the tumor opens externally — which is a very 
rare occurrence — there is a chance of recovery." 

This description shows the epidemic referred 
to to be the same dreadful one which killed a 
third of the inhabitants of England in the reign 
of Edward iii — the true ' ' black death. ' ' There 
have, indeed, been various intimations that it is 
gathering strength for another sweep over the 
earth, and with this possibility in view the gen- 
eral subject of epidemiology assumes an import- 
ance which cannot be gainsaid. 



Notes and Comments. 

Bemarkable and Gratifying Change. 

Sed movet ! A few years ago a late eminent 
professor in the Harvard Medical School wrote 
us that he looked with repugnance at any attempt 
to teach the public, especially women, physi- 
ology ; the same sentiment was forcibly expressed 
by the Dean of one of our leading medical schools 
here ; and there may be some old fossils in the 
way of journals and doctors in this country and 
England, who still entertain this decayed notion. 
But note this item from the British Medical 
Journal : "To meet the demand for higher cul- 
ture and wider knowledge for ladies, several of 
the University Professors in Glasgow have insti- 
tuted classes for ladies, in which lectures are 
given in the different branches of science. We 
are glad to learn that the course of lectures on 
the Elements of Physiology is well attended. 
Such a knowledge of the nature of the vital 
organs and their functions, as shall give some 
correct ideas with respect to the means by which 
disease may be avoided and health preserved, is 
most important for all. ' ' 



And note this outburst of the Lancet : "It is, 
beyond question, the high vocation of the medi- 
cal profession to preach the gospel of health. 
There must be a code of storm-signals, intelligible 
to the masses, who are perpetually exposed to 
the gravest risks from the extension and progress 
of disease, and it is the bounden duty of the 
profession to embrace every legitimate opportu- 
nity and means of teaching and enforcing the 
humane lesson of an orderly and clean life, in 
soundness of body and mind." Ten years more 
will see the American profession enlightened 
enough to advocate acts for the limitation of 
syphilis by registration and examination, and 
several other such now impossible reforms. 



Hereditary Transmission of Heart Disease. 

A remarkable example of this is recorded by 
Dr. Rezek, of Toplitz, in the Wiener Med. 
Zeitung. Of the pair from whom the family in 
question descended there is reason to believe 
that the mother suffered frOm heart disease. 
They left two sons and five daughters. Of the 
sons, one is still alive, anti suffers from heart 
disease ; the other is dead, and suffered before 
death from dropsy; his son, moreover, suffers 
from some cardiac affection. The other son, 
still alive, has suffered for some years from heart 
disease, but his children are healthy. Of the 
three daughters, one died from heart disease, 
and of her five children all are healthy, but one 
has married and has had three children, two of 
whom have the "blue disease" connected with 
heart troubles. The second daughter of the ori- 
ginal pair is still alive, and has suffered for 
many years from cardiac disturbances similar to 
that of her brother ; of her children, one daugh- 
ter has died of heart disease, and another has 
married and has borne a child with well-marked 
congenital heart disease. The third daughter 
of the original pair has not suffered from heart 
disease. 



Filocarpin as an Abortifacient. 

A late number of the Allgemeine Med. Central 
Zeitung quotes four cases recently reported by vari- 
ous observers, where the hypodermic use of pilo- 
carpin in pregnant women led to abortion. One 
case was four months gone, and aborted after the 
ninth injection. This should be an important 
caution against using this agent, which is growing 
in popularity, in pregnant women. As to whether 
it will prove of service in cases where the produc- 
tion of abortion is indicated for legitimate rea- 
sons, no observations have been reported. 



128 



Correspondence, 



[Vol. xl. 



On The Treatment of Ulcers, 
Prof. Nussbaum recommends to make an in- 
cision around the ulcer one-half an inch from its 
margin. This incision must go through the skin, 
and reach the cellular tissue above the muscles. 
It divides the numerous adventitious vessels de- 
veloped in the peri-ulcerated skin that feed the 
morbid process. In this way is cut off its direct 
and too liberal supply of blood. Into this canal 
lint is placed and left for twenty-four or 
thirty- six hours, long enough to prevent the sev- 
ered tissue from rejoining by first intention. 
This is especially important with the arteries ; 
they must not be allowed to unite. 

In a short time the ulcer will begin to shrink ; 
day by day the healing progresses, and in a week, 
or probably two, it will have disappeared. 

This method is, however, inferior to that of 
Syme, by blisters, and of Martin, by the elastic 
bandage. 



Induced or Symmetrical Anaesthesia. 

A remarkable observation has been made by 
M. Dumontpallier, a record of which is pub- 
lished in Le Progr6s Medical of December last. 
If the ether spray is directed to a limited sur- 
face on the right arm, we will say, until sensibil- 
ity as tested by the aesthesiometer is notably 
diminished, and then the sensibility be tested on 
the corresponding region of the left arm, it will 
be found that the sensibility there is also notably 
diminished, though in a less degree. This is not 
invariably the case, but is so in a large propor- 
tion of instances ; and that it is not a hj'^sterical 
phenomenon may be assumed from the fact that 
the subjects of the experiments were medical 
students. 



The Croton Oil Treatment of Naevus. 
An instance of this is given by Dr. H. F. Sig- 
ler, in the Michigan Medical Neivs. He writes : 
The tumor was situated in the centre of the left 
cheek, and in size about as large as a dime. I 
procured a cork the size of the tumor, into which 
I inserted several fine needles, letting the points 
project one- eighth of an inch. I then immersed 
the points of the needles in pure croton oil, and 
plunged them into the tumor. A little swelling 
followed, and several vesicles formed soon after. 
The second day a crust formed over the whole 
tumor. This was repeated three times, at inter- 
vals of five days, and no other treatment was 
required. 



— Erratum, — Page 43, column one, the tem- 
perature should read 102^ instead of 120i. 



Correspondence. 



The Antagonism of Alcohol to the Poison of Diph- 
theria. 

Ed. Med, and Surg. Repokter: — 

In your issue of January 4th an article ap- 
peared with the heading '' Diphtheria and Alco- 
hol," written by Dr. C. H. Lewis, of Jackson, 
Mich. Dr. Lewis refers to a monograph by Dr. 
C. N. Chapman, of Brooklyn, N. Y., upon the 
subject of the caption of this article. In your 
issue of January 11th, there is a notice of a re- 
publication, from the Temperance Record^ of the 
same monograph, by Dr. J. W. Sherfy, now of 
London, England, who approves Dr. Chapman's 
views. If my recollection is not at fault (the 
volumes of the Reporter, for many years taken 
by me being now at my home in Little Rock, 
Ark.), the production of Dr. Chapman first ap- 
peared in the Scientific American, some time in 
the year 1877, and was referred to by you in the 
Reporter. If I am wrong in this statement, 
you will do me a service by stating the facts. 

The object of this paper is not to discredit Dr. 
Chapman's discovery, but to claim the same dis- 
covery made by myself in the fall of 1860. To 
me, it is indeed unaccountable, that many prac- 
titioners of experience and observation, upon 
both continents, did not in the years past reach 
the same conclusions. My imperfect recollection 
pointed to 1861 or '62 as the date of the origin 
of my present views of the pathology and treat- 
ment of diphtheria, but a correspondence had 
within the last mouth, with Mr. G. W. Parish, 
of Salem, Roanoke county Va. (my home from 
1855 to 1863), furnishes me with the record of his 
first son's death, which occurred Oct. 23d, 1860. 
The little boy, twelve or fifteen months old, had 
diphtheria, but apparently not a very serious 
case. The false membrane was never extensive, 
and in a few days entirely disappeared ; the fever 
continued from the first only a few days. There was 
not the least obstruction in any part of the respira- 
tory apparatus. The patient was rather unusually 
pale, pulse rather feeble, but not above the ordi- 
nary frequency. His prospect seemed fair for 
recovery. Nothing but feebleness, depressed 
vital force, could be detected. After a few days 
in this condition, death closed the scene. 

Reflections upon the peculiar manner of death 
in this case established me in the blood poison 
theory and the alcohol treatment, which I have 
diligently pursued to this day, with unbroken 
success, when the patients have been seen in time 
and my remedies promptly employed. 

Soon after my discovery of the antagonism of 
alcohol to the poison of diphtheria, I made it 
known to Dr. John Rice (now deceased), of Cave 
Spring, Roanoke county, Va., who, after adopt- 
ing the practice, never lost another case of the 
disease, as he declared to me in person. After 
I came to this place, in 1863, I informed various 
physicians of my successful practice ; among 
them I recall Dr. Wade Culbertson, of Cave 
Springs, Ga.; Dr. Wm. Selman, of Texas Valley, 
Ga.; Dr. C. H. Gorman, of Alpine, Ala.; Dr. 
W. D. Hoyt, of this city, besides various other 



Feb. 8, 1879.] 



Correspondence, 



129 



persons not necessary to mention. My first pub- 
lication was made in the Reporter, Oct. 18th, 
1875, the first upon that subject on either conti- 
nent, as far as I have been able to investigate 
the matter. In the Reporter of Nov. 7th, 1876, 
I repeated my practice, with its success. In my 
formula the compound spirits of lavender is 
added, to give color and flavor, and the aromatic 
ammonia, as a solvent of the false membrane. 
The antidotal property of alcohol was distinctly 
affirmed in my first publication, in 1875. I pro- 
pose no injustice to any man, but claim that justice 
gives me the priorit}^ of the discovery, or at least 
its publication. 

It would seem to me that eighteen years' ex- 
perience, in hundreds of cases, at times six to 
eight in a family, ought to go far toward estab- 
lishing the value of a remedy which has not failed 
in a single instance, when fairly tried. Its anti- 
dotal quality is beyond all question, in my mind, 
against that scourge of our race, especially the 
young. J. H. Nowlin, m.d. 

Rome, Ga., Jan. 14th, 1879. 



Retained Placenta. 

Ed. Med. and Surg. Reporter : — 

June 1st, 1877, I was called to see Mrs. W., 
aged 30, the mother of five children, and in the 
third month of pregnancy with the sixth, who was 
suffering with symptoms of abortion. On inquir}^ 
I learned that the cause was excessive manual 
labor. An opiate procured freedom from pain, 
and rest. On the following day the pains re- 
curred, and in my absence a neighboring phy- 
sician was called, but not until the membranes 
had ruptured. He administered ergot and the 
embryo was expelled. No serious hemorrhage 
following, the case was allowed rest, to await the 
renewal of the pains, which had entirely ceased. 
In a few days the woman was up and about, ap- 
parently as well as usual. 

On the 15th of April I was summoned in great 
haste, as the messenger said Mrs. W. was bleed- 
ing terribly. On my arrival I found the patient 
was entirely free from pain. She said that for 
three days she had suffered from retention of her 
menses, which had been regular, and had not 
been attended by more pain than usual since her 
abortion. A few minutes before my arrival a 
considerable discharge of blood took place ac- 
companied by a body as large as a black walnut 
and the shape of the uterine cavity. After its 
discharge all pain ceased. On examination the 
body proved to be a placenta, which had undoubt- 
edly been retained in the uterus /or ten and a 
half months from the period of the abortion, or 
over one year from the time of conception. The 
placental mass was sent to Davenport and was 
there examined by several physicians, most of 
whom pronounced it a fibrous tumor, owing, 
probably, to the hard, fibrous character it had 
assumed under uterine pressure. 

The fact that the expulsive pains were not re- 
newed after the escape of the embryo, and that 
the presence of this mass in the uterine cavity 
did not occasion severe dysmenorrhoea, made the 
case one of more than usual interest. 

LeClaire, Iowa. J. A. DeArmoxd, m.d. 



Dangers in the Use of Calcined Magnesia as a 
Laxative. 

Ed. Med. and Surg, Reporter: — 

A few weeks since a lady, about 55, came to 
me with a uterine tumor, periuterine fibroid, of 
immense size, covering the fundus, extending 
above the navel, and in a great, irregular mass on 
both sides, and to be felt behind the uterus by 
vaginal digitation. This diagnosis, coming from 
several eminent physicians, was acquiesced in, 
undoubtingly, by myself. 

The patient came to me to be broken of mor- 
phine taking. Under the lessened use of mor- 
phine, intense pain in the ''uterine tumor" set 
in, of a contractile type, for the relief of which 
friction, electricity, very hot fomentations, very 
copious hot rectal enemata were used, being moder- 
ately effective. The enemata, on ejection, was 
black, leaving a granular sediment in the 
vessel, partly (shown by microscope to be) old 
blood and partly amorphous particles. Vomit- 
ing of the same liquid was persistent to such an 
alarming extent as to suggest cancer of the stom- 
ach, or intestines, to the consulting physicians. 
Obstinate constipation being present, a large 
amount of purgative medicines was used, without 
effect, including hydrarg. bichlor. and olei tiglii. 
The patient, after two weeks, at last, complained 
bitterly of something pressing down in the back 
passage. 

On introducing the finger, I felt something, 
nearly as large as, and feeling quite like, a fetal 
head. 

It was with difficulty broken, and removed 
from the rectum, and found to consist of calcined 
magnesia, blood, faeces, etc. The patient had 
taken the magnesia, with vinegar, for many years, 
in increasing quantity, as the morphinism in- 
creased the constipation. An incredible amount 
passed the bowel, and at the same time the 



uterine tumor" passed away. 
EJmira, N. Y. 



A. A. G. 



Case of Epilepsy, with Treatment. 

Ed. Med. and Surg. Reporter : — 

On the 31st of December, 1877, I was called 
to see John James, of Frenchtown (a colliery 
near Hazleton, Luzerne county), and found him 
suffering with epileptic con\Tilsions, recurring- 
three or four times every twenty-four hours, and 
had been doing so for nearly a year ; prior to 
that, extending back nearly twelve years, he had 
been having them once or twice daily, with an 
occasional suspension of a month or six weeks. 
Upon inquiry, I found he had been treated by 
the best local talent, and also eminent men of 
both Philadelphia and New York, and that he 
had taken all the very best remedies for this dis- 
ease, and taken them regularly, faithfully, and 
for sufficient length of time, under the ad^'^ce and 
direction of these men, but all to no, or but very 
temporary, aid or relief, and I was just upon the 
point of saying I could do nothing for him, when, 
on glancing over the prescriptions (many of which 
he retained), I observed that he had always taken 
his medicine after meals. Upon further inquiry, 
I found he ate his breakfast at 7 a.m., dinner at 
12 M., and supper at 5 or 6 p.m. ; these replies 



136 



News and Miscellany. 



[Vol. xl. 



manifestly indicated that during a portion of the 
twenty-four hours he was not fully under the in- 
fluence of the medicine. Upon this point I had 
based my treatment, and commenced giving him 
two of the very remedies he had been taking, viz, 
bromide of potassium and ammonium, in a solu- 
tion of citrate of iron, but ordered it every eight 
hours, always eating an ounce of bread before 
and after taking each dose of medicine. He took 
the first dose at 6 a.m., Januar}^ 1st, 1878 ; at 11 
A.M. he had a convulsion, and up to this writing, 
January 4th, 1879, he has not had a convulsion, 
and for eight months has been following his oc- 
cupation, as a miner. The only point I wish to 
make and impress is, that the same medicine 
given three times daily after meals failed, whereas 
when given at regularly divided intervals through 
the twenty-four hours they succeeded. 
Hazleton, Fa. I. R. Casselberrt, m.d. 



The Gynecological Wire Loop. 

Ed. Med. and Surg. Reporter : — 

I wish to call the attention of the medical pro- 
fession to a gynecological instrument of my in- 
vention, which I call the gynecological wire loop, 
uterine tractor, for seizing and bringing forward 
the mouth of a much enlarged uterus, when it is 
very far down and far back in a narrow, deep, 
virgin vagina. 

The loop may be made of any wire, nickel 
plated, and of any size desirable, from an inch 
to an inch and half in diameter, and the point 
bent a very little up, so as -the more readily to 
seize the os. The whole length of the instru- 
ment may be some ten or twelve inches. The 
above instrument I think much better than the 
hook, in many cases. N. L. Folsom, m.d. 

Portsmouth^ N. H., January, 1879. 



News and Miscellany. 

Report of the Board of Experts Who Have Been In- 
vestigating the Yellow Fever Epidemic. 

The Board of Experts, authorized by Congress 
to investigate the yellow fever epidemic of 1878, 
submitted their report to the joint Congressional 
committee at its meeting on Jan. 31st. After 
stating that their investigation has been incom- 
plete because of the urgent demands for public 
health legislation during the present session of 
Congress, the report says : ' ' The board is unani- 
mous in the opinion that the investigation of the 
late epidemic should be completed, and that the 
study of the natural history of yellow fever should 
be systematically pursued, and especially that the 
inquiries should embrace the perpetually infected 
parts of the West Indies, whose fields give 
greatest promise of practical results as the re- 
ward of faithful scientific inquiry. " It is accord- 
ingly recommended that two or three skilled ex- 
perts be charged with the completion of the study 
of the late epidemic, which can be concluded in 
a few months, and that at least two such experts 
be authorized to proceed to the West Indies, 
there to make a more thorough study of yellow 
fever than has ever yet been undertaken, and that 



they be accompanied by an experienced micro- 
scopist. It is further recommended that the 
necessary steps be taken by Congress to secure 
the co-operation of the Spanish and other foreign 
governments, through an international commis- 
sion or otherwise, in an earnest effort to ascertain 
the cause or causes which perpetuate the yellow 
fever from year to year in the West India Islands, 
and to devise ways to remove the cause or causes, 
or to lessen the chances of transporting the poison 
to the United States or other countries. 

The report further recommends the establish- 
ment of a thorough quarantine system through the 
appointment of two classes of medical officers — 
first, medical officers of health to serve in foreign 
ports from which we receive importations of yel- 
low fever and cholera ; secondly, medical officers \ 
of health to have charge of quarantine stations I 
and to supervise inter- State travel and traffic from 
infected places in times of epidemic. These two 
classes of medical officers are considered indis- 
pensable to any method of quarantine which does 
not involve complete suspension of intercourse with 
infected parts. The board regards it especially 
important that the selection of these officers should 
be made from men skilled in medicine and sanitary 
science, as the success of any modified quarantine 
scheme depends almost entirely upon the compe- 
tency and fidelity of its medical officers. It is also 
deemed of great importance that the means may be 
provided by Congress for obtaining trustworthy in- 
formation by telegraph in respect to the outbreak 
and progress of cholera, yellow fever and other 
epidemic diseases in all parts of the world, and 
the departure of vessels from infected ports bound 
for ports in the United States. The diffusion of 
trustworthy information representing the exist- 
ence and progress of preventable diseases at 
home and abroad should be encouraged as tend- 
ing to avert the evils of panic and to promote 
measures of prevention. The carrying into effect 
of an efficient system of quarantine contemplates 
a central authority, so organized as to gain 
strength from and give strength to State and mu- 
nicipal health organizations, and the report re- 
commends the establishment of an advisory board 
of health, to be composed of men eminent in 
sanitary matters, who, together with the chief 
officer of the Health Department, shall frame all l 
needful rules and regulations for carrying into f 
effect, subject to the approval of the President, 
such national public health laws as may be 
enacted. 

The board dwell at considerable length upon 
the origin, cause and distinctive features of yel- 
low fever, and say that it is a specific disease and 
is produced by the introduction into the human 
organism of a specific poison. The specific 
poison of yellow fever has never been chemi- 
cally or microscopically demonstrated, nor in 
any way made evident to the human senses. 
Nevertheless, we hold that it is safe to assume 
that it is material and particulate, and endowed 
with the ordinary properties and subject to the 
ordinary laws of material substances. 



— There are more than sixty American medical 
students in Vienna this year. One of these is a 
lady. 



Feb. 8, 1879.] 



News and Miscellany. 



131 



Personal. 

— The venerable Professors, Fauvel and Noel 
Gueneau de Mussy have been retired from the 
Hotel Dieu at Paris, having reached the limit of 
age allowed by law. 

— Professor Billroth has performed the opera- 
tion of oesophagotomy again, with the hope of 
lengthening the life of a man suffering from 
stricture of the oesophagus. This is the fifth oc- 
casion, we understand ; and the success is en- 
couraging, considering the great benefits the 
operation has been able to afford more than once. 

— French medicine has just sustained a highly 
regretable loss in the person of Antoine Pierre 
Ernest Bazin, formerly physician to the St. 
Louis Hospital, who attached a seal of originality 
to his investigations in dermatology, and created 
a generation of faithful disciples. His views on 
the syphilides, and still more his doctrine of the ar- 
thritides, are those which excited most attention, 
revealing as they did a talent both for observation 
and generalization. 

— Professor Brown- Sequard began his course 
of lectures on Physiology in December, at the 
College de France. In his opening address he 
made known the subject which it was his inten- 
tion to treat. He proposed to combat all the 
doctrines which are actually received upon the 
physiology of the brain, and especially those 
which have reference to cerebral localization. 
He would study the mode of action of the brain 
upon the spinal cord, and discuss the question 
whether it is right to admit the existence of two 
brains or one only. He would then review all 
the lesions of the brain which are capable of pro- 
ducing physiological or morbid phenomena. 



Smallpox in Brazil. 

South America is having an epidemic of small- 
pox, which threatens to cause as much suffering 
as the yellow fever did in the South, or as the 
plague is now creating in Eastern Europe. In- 
telligence is at hand giving information of the 
ravages of the disease in some parts of Brazil. In 
the city of Ceara there were 11,075 deaths in 
October, 9844 in November, and 17,391 from 
December 1 to 11. In the latter part of Decem- 
ber the death rate was 900 a day. There is also 
a famine, and until the latter part of December, 
when the neighboring provinces sent pecuniary 
assistance, people were dying off of starvation, 
having neither water nor grain. The population 
of Ceara, according to estimates based upon the 
last census, is less than 40,000, but it has been 
much swollen since the famine began, when peo- 
ple from the interior began to flock there. 



The Medical Staff of the Kussian Army. 

The Russian Medical Gazette states that in 
1876 the strength of the medical staff of the Rus- 
sian army was 2300. In the course of that year 
120 medical men were added to the staff; in the 
course of the next year(1877) the additions were 
900 ; and in the following year (1878) 760. The 
maximum number of medical men attached to 
the army during the last war was 4000. 



Notes on Health Kesorts. 

The number of visitors to Florida this winter 
is less than usual. Cold of an unusual degree of 
severity was experienced the last of December, 
and it was feared the orange groves above Jack- 
sonville have suffered. Serious complaints con- 
tinue to be made of the hotel accommodations, 
except at three or four points. 

Santa Barbara and Southern California have 
also experienced unusually cold and variable 
weather. A physician who recently returned 
from spending a year in that region tells us that 
the most correct description of the health advan- 
tages of that climate he has ever read was that by 
the late Dr. Ralph N. Townsend, published in 
the Reporter, two years ago. 

The celebrated Swiss resort, Davos am platz, 
5200 feet above sea level, has had an unfavorable 
winter so far. The Fohn or south wind has 
blown in an unprecedented manner, melting the 
snow and producing an unusual amount of 
rain and dampness. There were, at Christmas, 
180 Americans and English there, one-half of 
whom were consumptives. 



OBITITARY NOTICES. 

Dr. John B. Biddle. 

Hall of Jefferson Medical College, 
Philadelphia, January 20th, 1879. 

At a meeting of the Faculty, held this day, 
the death of Dr. John B. Biddle, Professor of 
Therapeiitics and Materia Medica, and Dean 
of the Faculty, was announced, whereupon, the 
following was ordered to be entered upon the 
minutes of the Faculty: — 

"The Faculty of Jefferson Medical College find 
themselves plunged into the deepest sorrow by the 
death of their fellow-member. Dr. John B. Biddle, 
Professor of Therapeutics and Materia Medica 
and Dean of their body, which occurred on the 
evening of the 19th instant. As a friend, they 
feel sadly the void thus created, and mourn over 
the departure of a greatly loved companion. 
Endeared to them by his noble qualities of head 
and heart ; as their colleague and executive offi- 
cer, they realize the irreparable loss of a sound 
and sagacious thinker, an able and successful 
teacher, and a faithful, experienced and judi- 
cious executive, whose untiring zeal and earnest 
labors in his own department, and for the school 
at large, have contributed so much to maintain 
the usefulness and advance the reputation of Jef- 
ferson Medical College. 

"The Faculty feel that words are inadequate 
to express their sense of this bereavement, but 
desire to make record of the estimate in which 
they held the deceased, whose memory they will 
ever cherish with sincerest affection. 

"They desire to convey to his sorrow-stricken 
family their warmest sympathy, trusting that in 
the knowledge they have of the esteem in which 
he was held in the community, and the love 
which was borne him by all his co-laborers and 
friends, and, that he has left them in the assur- 
ance of a Christian faith for that larger life which 
is eternal, they find comfort and consolation. 

'"''Resolved, That a copy of this testimonial of 



132 



News and Miscellany, 



[Vol. xl. 



the Faculty be transmitted to the family of Dr. 
Biddle, and also to the honorable Board of 
Trustees, and that the Faculty will attend his 
funeral in a body, 

Resolutions of respect were also passed by the 
Board of Inspectors of the Philadelphia County 
Prison, of which Dr. Biddle was President. 

Dr. Nathan Mitchell. 

Died at his home in Colon, St. Joseph county, 
Michigan, January 26th, in the seventy-first year 
of his age. He was born November 27th, 1808, 
in the town of Calais, Washington county. State 
of Vermont ; his father being a farmer, he was 
early trained to agricultural pursuits, which he 
followed until he became of age, securing at the 
same time more than an average education from 
the limited educational advantages of those days. 
He immediately commenced the study of medi- 
cine, and in 1880 entered the Middleburg Medi- 
cal College, and graduated in 1834. Starting 
immediately for the far west, as it was considered 
in those times, he located in Trumbull, Ashta- 
bula county, Ohio, and practiced his profession 
successfully in that place for five years. In 1839 
he came to Michigan, and located in Colon, St. 
Joseph county, where he has been ever since. 
Commencing as he did with the early settlers, he 
has shared all the changes of a new country with 
them, and for forty years has been a faithful 
physician to the people, riding far and near in 
an early day, to relieve suffering, and ofttimes 
without money and without price. 

About two years ago a cancer made its appear- 
ance on his lip, and has steadily progressed, 
destroying all the lower portion of the face, 
gums, jaw, and neighboring ganglions. 

Dr. Tardieu. 

The eminent Dr. Tardieu, of Paris, died last 
month. Not a few remarkable works on patho- 
logical and clinical medicine has the world to 
thank this great mind for, the latest of which, 
bearing the date 1879, is entitled '^ Etudes Medi- 
co-Legal sur les Blessures.'''' Tardieu was, per- 
haps, best known for his " Dictionnaire Hygiene 
Piiblique,^^ and also for his celebrated hrochure 
'■''Etudes Medico- Legal sur les Attentats aux 
Mceurs,^'' which in a short space of time has been 
through seven editions, and is, so far as we are 
aware, the only scientific treatise ever written on 
this subject. 

Dr. S. H. Shannon, 

A graduate of Jefferson Medical College, of the 
class of 1836, died at Schuylkill Haven, Jan. 17th, 
after a lingering illness. He was born at Shan- 
nonville. Pa., in 1814. The deceased had a 
varied and extensive practice of forty years, 
which gave him a position as a skillful practi- 
tioner. He was one of the largest property 
holders in the county. Dr. Shannon was a friend 
and benefactor to the poor, to whom his services 
were dispensed with liberality, and who will have 
occasion to deeply mourn his loss. 



— -Malarial disease is reported, on official au- 
thority, to have decreased in New York since 



1872, although the popular belief is that such 
disorders are constantly increasing. The Sani- 
tary Inspector of the Board of Health remarks, in 
a report to that body, that the virulence of malaria 
noticeable prior to 1872 has been much modified 
of late years. 



QUERIES AND REPLIES. 

Br. J. E. G., of PFis,— The sub-chloride of bismuth, 
or the precipitated carbonate of zinc, tinted with car- 
mine to a flesh color, and diluted to the consistence of 
cream, would be an appropriate mixture to conceal 
tattoo marks. 

Br. A.^ Ala. — " Does the American Medical Associa- 
tion sanction the making of contracts with families by 
physicians ?" 

Ans. — No direct sanction has been given this prac- 
tice. It has been left to the discretion of members 
and the varying demand of circumstances. The gen- 
eral sentiment is averse to such contracts. 

Br. V. F.— " Is it a violation of the code to publish a 
post-mortem case in the daily journals, stating the 
physicians present, etc. ?" 

^ns.— An officer of the American Medical Associa- 
tion informs us that such a procedure is not in violation 
of the code ; but that it meets with general disapproval 
of the members. 



MARRIAGES. 



Brennisholtz — HoLLTNBERGBR,— December 25th, 
by Rev. J. H. Stewart, Dr. A. K. Brennisholtz and 
Annie HoUenberger, all of Greencastle, Pa. 

Cawley— Clauser.— On December 31st, 1878, by 
Rev. E. J. Fogel, Dr. J. Irving Oawley, of Allentown, 
Pa., and Miss Annie M., daughter of Joel Clauser, 
Esq., of Ballietsville, Pa. 

Erwin— Sleeper.— In North Troy, Vt. January ist, 
by Rev. G. H. Parker, A. F. Erwin, m.d., and Ella E. 
Sleeper, both of Newport, Vt. 

Gatden— Perkins.— At the residence of the bride's 
father, on the 26th of December, 1878, by Rev. Thomas 
Lansdell, Dr. Agrippa G-ayden and Miss M. O. Perkins, 
both of E. Feliciana, La. 

Ludlow— Carnochan.— On Thursday, January 16th, 
at Grace Church, New York, by the Rev. Henry O. 
Potter, D.D., assisted by Rev. J. Breckenridge Gibson, 
D.D., and Rev. J. C. Tebbetts, Thomas W. Ludlow and 
Harriet Frances, daughter of Dr. J. M, Carnoohan. 

Sayre—Pomeroy.— On "Wednesday, January 15th, at 
St.Thomas' Church, New York, by Rev. Dr. Morgan, as- 
sisted by the Rev. Henry C. Potter, of Grace Church, 
Lewis Hall Sayre, m.d., and Alice, only daughter of 
William L. Pomeroy. 



DEATHS. 

Alden.— In New York, on Sunday, January 19th, 
Mary Lincoln, daughter of Dr. Charles and Kate Lin- 
coln Alden, in the 7th year of her age. 

Baylor.— In Denver, Colorado, on January 13th, 
1879, Dr. John C. Baylor, of Norfolk, Va. N 

Benedict.— At Yonkers, N. Y., Sunday, 19th ult., of 
scarlet fever, William Newell, son of Dr. A. C. and 
Irene Newell Benedict. 

Biddle.— In Philadelphia, on the evening of Sunday, 
January 19th, Dr. John B. Biddle, in the sixty-fifth 
year of his age. 

Eakins.— Dr. F. R. Eakins, of Macon, 111., of cancer' 
of the stomach, January 27th, 1879. 

White.— January 8th, at 5 o'clock, p.m., Dr. John 
White, in his 86th year. 

Williams.— On the 15th ult., Agnes, wife of Dr. W 
Williams, and daughter of John J. and Rachel S, 
Rowan. 





-"-^ 



WHOLE No. 1146. J 



FEBKUARY 15, 1879. 



[VOL. XL, No. 7. 



THIE 



MEDICAL AND SURGICAL 

EDITED BY D. G. BRINTON M. D. 



Terms of Subscription, FIT£ DOLiluARS per annnm, in advance.— ISingle Copies Ten Cents. 



O O IVTETSr TS : 



ORIGINAL DEPARTMENT. 

COMMUNICATIONS. 

Corson, Hiram.— Thoughts on Midwifery 133 

Ev* RETT, J . T.— The Physiological Cure of Hemor- 
rhoids 136 

HOSPITAL REPORTS. 

Pennsylvania Hospital— Clinic of Professor Da- 
Costa— Chronic Pleurisy with Efiusion. The 
Question of Aspiration Influenced by Lung 
Complication— Typhoid Fever. Elements of Prog- 
nosis in Albuminuria, and the State of the Heart. 
Rational Treatment— Multiple or Disseminated 
Sclerosis, Following Spinal Meningitis. Its Clin- 
ical Features and Treatment 139 

New York Hospital— Clinic of L. Duncan Bulkley, 
M.D.— Diseases of the Skin — Acne , 142 

EDITORIAL DEPARTMENT. 

PERISCOPE. 

Experiments on Malignant Pustule 144 

The Etiology and Treatment of Epilepsy 144 

Surgical Treatment of Anasarca 144 

The Therapeutic Value of Oxygen 145 

Esmarch's Bandage in Popliteal Aneurism 145 

REVIEWS AND BOOK NOTICES. 

Notes on Current Medical Literature 146 

BOOK NOTICES. 

A Practical Treatise on the Diseases of the Testis 
(Curling) 146 

On Loss of "Weight, Blood Spitting, and Lung Dis- 
ease (Dobell) 147 

A Century of American Literature (Beers) 147 



A Practical Manual of Diseases of Children (Ellis) 117 
A Tabular Handbook of Auscultation and Percus- 
sion (Clapp) 147 

Lecture Notes on Chemical Physiology and Path- 
ology (Vaughan). 147 

editorial. 
The Darwinian Doctrines as Applied to the 

■ Study of Disease 148 

The Advance oe the Plague 149 



NOTES AND COMMENTS. 

Results of the Contagious Diseases Acts . 

Poisoning by Chlorate of Potash 

Relation of Diphtheria to Potato Blight. 



153 

150 

150 

Suggestion for Sleeplessness 151 

Syphilitic Milkmen 151 

CORRESPONDENCE. 

Ice Treatment of Pseudo-membranous or True 
Croup in Children, and Acute Laryngitis in the 

Adult (Norris) 151 

Leonurus Cardiaca in Asthma (Spottiswood) 152 

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Original Department. 



Communications, 
thoughts on midwifery, no. 3. 

BY HIRAM CORSON, M.D., 

Of Conshohocken, Pa. 
After the close of the discussion on the topics 
named in my former papers. Dr. H. P. C. Wilson, 
of Baltimore, related a case of labor followed by 
hemorrhage. "The labor was normal and no 
necessity existed for interference, but, at the 
earnest solicitation of the woman, small doses of 
chloroform were given, so that consciousness was 
destroyed just before the birth of the child. The 
uterus was grasped and made to follow the child, 
so as to secure expulsion of the placenta and 
guard against hemorrhage." While the doctor 
tied the cord, the nurse held the contracted uterus, 
but as soon as the child was removed the doc- 
tor's hand again took charge of the uterus. "The 
placenta was easily taken away, and though up 
to that time no hemorrhage had occurred, in a 
few seconds after blood deluged the bed and ran 
down upon the floor." And now the doctor 
flew to the rescue of his patient ; one hand, car- 
rying a piece of ice, was pushed into the womb 
while the other continued its grasp on the abdo- 
men ; the womb contracted, pushed the hand and 
clots out, and all seemed well. Ergot was then 
given, but in a few minutes the uterus was again 
enlarged ; again the hand and ice were used, with 
like result, and so on it went, despite ergot (by 
the mouth, rectum, and hypodermically), and 
both hands, two times more, all within a very 
short time; but as the woman's pulse was then 
frequent and feeble, he again passed his hand for 
the fifth time into the uterus, and used his finger 

133 



nails as a curette, thoroughly "raking" the 
placental surface, and the hand was expelled. 
A second raking was, however, given it in a few 
minutes, because the relaxation of the os and 
cervix permitted the hand to be pushed in to 
the womb. "She did not lose a teaspoonful of 
blood after the first raking. " " From his experi- 
ence in this single case, he said he should, in a 
future case, where prompt contraction could not 
be produced, immediately use his hand as a 
curette to the placental surface." He did not 
think the hemorrhage was due to the use of chlo- 
roform, for "in twenty-eight years, though using 
it in nearly every case, he had only two cases of 
troublesome post-partum hemorrhages." There 
was no discussion on this subject then, and I will 
pass it for the present, to notice the next paper, 
by Prof. R. A. F. Penrose, of Philadelphia. Allow 
me to quote somewhat at length from the report 
of the meeting published in the October No. 
of the American Journal of Obstetrics, edited by 
Paul F. Munde, m.d. "The author first spoke 
of the 'appalling character' of such a hemorrhage, 
and the necessity for instant and efficient treat- 
ment. It was in these cases that knowledge 
meant life and want of knowledge meant death 
to the sufferer. A prompt and intelligent treat- 
ment he regarded invariably successful." Let 
us not forget this last sentence ; we may have 
occasion to call it up again. ' ' The most powerful 
predisposing cause of hemorrhage was a peculiar 
idiosyncrasy of the woman, which gave rise to a 
peculiar flaccidity of the uterus; a treatment 
which would cure one case might be useless in 
the treatment of another." Dr. Penrose then 
reviewed the ordinary treatment by cold, injec- 
tions of warm water to wash out the uterus, injec- 



134 



Communications. 



[Vol. xl. 



tions of persaltsof iron, ortincture of iodine, actual 
cautery, friction over abdomen, etc. The actual 
cautery was, he said, the most certain to excite 
the uterus to contract, but was not allowable, be- 
cause of the danger to the woman's life ; the injec- 
tion of the persalts of iron, too, was efficient, but 
the same objection to their use came up, "as their 
action sometimes resembled that of the red-hot 
poker ; ' ' and the tincture of iodine was seldom 
at hand. The great desideratum was some reme- 
dy accessible, of easy application and efficient, 
and not likely to produce injurious after-effects, 
and this he was pleased to say he had found in 
common vinegar. It presented the following ad- 
vantages: — 

"1. It could be easily obtained, easily and in- 
stantly applied, and without special apparatus. 

"2. It always cured the hemorrhage ; or rather, 
it had never failed in his practice. 

"3. It was sufficiently irritating to excite the 
most sluggish uterus to contraction, and yet not 
BO irritating as to be subsequently injurious. 

"4. It was an admirable antiseptic. 

"5. It acted on the lining membrane of the 
uterus as an astringent. 

"The remedy was applied as follows : saturate 
a rag with vinegar, carry it into the cavity of the 
uterus and squeeze it. In most cases the bleed- 
ing ceased as if by magic. But if it should fail he 
would resort to a solution of the persalts of iron, 
though aware that the patient loould he placed in 
a dangerous position from its use. He believed 
the salts of iron were seldom or never to be 
employed for the arrest of post-partum hem- 
orrhage."* Such are the opinions of Prof. Pen- 
rose, and as they will go abroad over the whole 
land, influencing the opinions and giving char- 
acter to the practice of thousands of practitioners, 
it may be useful to scan them closely. There 
was considerable discussion by members. All 
agreed that uterine inertia was the cause of 
the hemorrhage, and uterine contraction the only 
preventive of it. The vinegar was not regarded 
with great favor, save by Dr. White, of Buffalo, 
who "was surprised that it had not occurred to 
him to use it in this difficulty, as he had for many 
years used it to arrest hemorrhage when operating 
about the uterus and vagina." Dr. Thomas, 
of New York, could see no specific action in 
vinegar, or iron, or iodine, or alcohol, or hot 
water ; they were only local irritants, and his in- 
quiry " whether the uterine inertia was primary 
or secondary," was most timely, and should have 
received more attention. He thought, if well 
managed, the uterus would almost always con- 
*^ pp. 866, 887, Trans. Am. Q-ynecological Soc. 



tract. Dr. Lyman, of Boston, and Dr. Atlee, of 
Lancaster, Pa., passed by the vinegar and de- 
pended on introduction of the hand. Dr. Albert 
H. Smith, of Philadelphia, made a few excellent 
remarks ; they were to the point and from posi- 
tive convictions. " If the uterus was empty it 
would contract, and if it contracted hemorrhage 
would cease." To prevent hemorrhage he had 
for ten years used hot water in all his cases, and 
had come to look upon water at 110° Fahrenheit 
and a vaginal syringe as an indispensable part of 
the obstetric armamentarium. ' ' He favored turn- 
ing out clots by the hand. Dr. Campbell, of \ 
Georgia, had practiced raising the lower end of 
the bed, turning out the clots, and using ice on 
the abdomen and in the vagina. Was favorable to 
iodine. Dr. Engleman, of St. Louis, used the 
iron by saturating cotton with it and then carrying 
it into the womb ; ' ' relied on it;' ' had seen no bad 
symptoms follow its use. Dr. James Trask, of 
Long Island, referred to cases where iron had 
caused death. He always had iodine with him, 
for use if needed. Dr. Bozeman, of New York, 
" would have ice in one hand, on the abdomen, 
while the other was clearing out the uterus ; and 
during all this time the uterus should be firmly 
grasped, as a surgeon would grasp the femoral 
artery in secondary hemorrhage." Dr. James 
Chadwick, of Boston, thought the perchloride 
of iron dangerous ; in one of his patients death 
followed its use. Dr. Barker thought that if other 
usual remedies failed, there was no method so good 
as the introduction of the hand. Dr. Wilson, of 
Baltimore, had never used iron ; " he relied on 
the hand as the best therapeutic agent. ' ' 

Here we have the measures resorted to by 
these eminent men, several of wht)m are teach- 
ers, and we may, therefore, regard them as the 
best means of safety at our command. And now, 
what are they ? First, in all cases, pressure on they 
abdomen — and that at once, whether there was 
hemorrhage or not ; or hot water injection, as a 
preventive ; or iron solutions ; or iodine ; or 
turning out the clots by the use of the hand, to 
which, by Dr. Wilson, is added scratching or 
raking that part of the womb where the placenta 
had been attached, by the finger nails. Throw- 
ing all these ^ide, Dr. Penrose relies on the 
mere introduction of a rag wet with vinegar — and 
he desires us to regard the presence of the vine- 
gar, not the presence of the hand, as the efficient 
agent in producing contraction ; he and some of 
the others regard the persalts of iron as danger- 
ous to life, and yet, he says, he would use them — 
not if all other safe means failed, but — if the 
vinegar should fail. Is not this unsafe teaching 



Feb. 15, 1879.] 



Communications, 



c-iy 



to the students who listen to him this winter? 
Shall they go forth to practice instructed, in the 
event of hemorrhage continuing after the failure 
to arrest it by ''a rag wet with vinegar," to re- 
sort at once to a means the action of which he 
has said '' sometimes resembled that of the red- 
hot poker?" Are there no other means which 
might follow the vinegar failure ? The young 
man has failed to arrest it by vinegar — which, as 
already declared by Dr. J. G. Thomas, has no 
specific action — and then, by direction of his 
teacher, resorts at once to a remedy which the 
same teacher has declared is dangerous, some- 
times acting like the red-hot poker. Where are 
the remedies and resources which proved efficient 
in the hands of Burns and James, 60 years ago, 
and continued to be a successful treatment in the 
hands of Dewees, who impressed them on the 
minds of his class in the University of Pennsyl- 
vania half a century since ? means which have 
proved as efficient, too, in the hands of their 
pupils, during the years from that time to the 
present, as ever human means have been in any 
disease. Has Dr. Penrose forgotten those 
means? — or proved their inefficiency? Or are 
they ignored, that a new remedy may be intro- 
duced which shall be hereafter closely associated 
in the minds of the profession with the name of 
its discoverer ? The inference is that he believes 
them valueless, for so conscientious a physician 
would not wantonly reject any means which gave 
promise of success ; nor would he, occupying 
the position that he does, discredit the teachings 
of his eminent predecessors in the Chair of Ob- 
stetrics — Professors James, Dewees and Hodge. 
Have we improved on the teachings and practice 
of these physicians? was there a single safe 
remedy spoken of in the recent meeting that was 
not used by them ? Burns, to produce contrac- 
tion of the womb, and thus arrest flooding, used 
"friction and slight pressure on the belly over the 
womb ] also ice or sudden dashes of cold water 
on the bare abdomen ; and carried a sponge with 
cold water into the womb by the hand, and 
even ice itself, with 'happy effects.'" But, he 
says, "In general, however, the external appli- 
cation of cold will be sufficient to save the pa- 
tient, and I have never known bad consequences 
to result from it." In a foot note at page 506 of 
his Principles of Midwifery, published in 1823, 
he refers to Saxtorph's injections of vinegar and 
cold water, and to Pasta' s use, in the same way, 
of "alcohol and acids, to cauterize, as it were, the 
mouths of the uterine vessels, which cannot fail 
to cause inflammation." And on page 507, in a 
foot note, he refers to what he calls " a novel 



mode of restraining hemorrhage," by carrying a 
lemon which has been deprived of its skin, 
so as to expose its cells, into the cavity of 
the womb, and then, when the uterus begins 
to contract by reason of the presence of 
the hand, the lemon must be suddenly squeezed, 
so as to squirt the juice on to the lining mem- 
brane of the womb. Here we see that the 
introduction of the hand, the friction and pres- 
sure on the abdomen, the use of cold water and 
ice internally and externally, and even the use 
of the lemon (now so frequently spoken of by 
young graduates as Dr. Penrose's remedy) and 
vinegar, were all in use by others and published 
by Prof. Burns sixty years ago. 

Professors James and Dewees, when lecturing 
to their pupils, fifty years ago, spoke earnestly on 
this subject, but did not frighten them by exag- 
gerated accounts of the danger of hemorrhage. 
Dr. Dewees, in his Midwifery, says, " It is neces- 
sary, in this hemorrhage, that the iiterus should 
contract before it can possibly- be arrested, and 
here, in uterine hemorrhage, I rest my great de- 
pendence upon abdominal frictions, the acetate 
of lead, ergot, cold applications, etc." It was my 
fortune to hear both those eminent men impress 
on the minds of their pupils the importance of 
friction and light pressure, and grasping of the 
abdomen, to excite the uterus to action — but never 
that continued, unremitted, heavy pressure now 
so much in vogue. Dr. Dewees, when speaking 
of the concealed hemorrhage, says, " the hand 
must be introduced into the uterus and the co- 
agula suffered gradually to escape, while the 
uterus is gently stimulated by the hand passing 
cautiously over its surface, and when it is found 
to contract upon it, it may be slowly withdrawn." 
What caution and gentleness are here inculcated, 
and how confident he is of success. Such teach- 
ing produced no alarm in the minds of his pupils. 
He saw no " appalling" danger. Long and suc- 
cessful experience had shown him that death 
from hemorrhage would be a very rare thing, 
even if the patient were without medical aid. Dr. 
Hodge, too, when teaching the pupils of the Uni- 
versity of Pa. , depended on like means. If he 
had believed that the injection of the solution of 
any substance — iron, or iodine, or any other 
thing — was dangerous ; that it was in its action- 
"somewhat like the red-hot poker," would he 
have recommended its use, without first resorting- 
to those other means which had always proved 
successful in the hands of his predecessors, and 
had never failed in his own? Those eminent 
men, Burns, James, Dewees and Hodge, were 
not ignorant in relation to the use of vinegar in 



J 36 



Communications, 



[Vol. xl. 



uterine hemorrhage. It had been used, tried 
effectually, too, not by rubbing a rag wet with it 
on the surface of a womb so covered with blood 
that it could not even touch the lining membrane, 
but, by injection ; washing it out, so that the 
vinegar could touch and stimulate the whole sur- 
face. But, though they knew of this treatment, 
they did not recommend it ; they had other safe 
means at hand. 

What were the means used by physicians 
throughout our State during the forty years pre- 
ceding the last ten years — for daring the last ten 
the obstetrical art has assumed a new phase — and 
were they successful ? They were those taught 
by the teachers in the great Philadelphia Colleges : 
frictions on the abdomen, ergot, removal of clots 
by introduction of the hand, and repeating this, 
if needful, again and again ; cold applied to the 
abdomen, or cold water poured from a height on 
the bare body, in bad cases. In some cases 
quinine or laudanum, or both. And were these 
means successful? Almost invariably so. And 
here let me say that, though flooding after the 
birth of the child is sometimes alarming, it is 
never fatal under the care of an intelligent phy- 
sician, who is not "in a hurry." It is not even 
a common occurrence where a labor is allowed 
to go through its first and second stages without 
interference. As proof of this, even Dr. Wilson, 
of Baltimore, who opened the subject by the re- 
port of a bad case, but which he cured by ' ' raking' ' 
the placental surface with his finger nail, stated 
that, " in an experience of twenty-eight j^ears, he 
had had only two cases of troublesome post- 
partum hemorrhage." Only two troublesome 
cases! Notonef^tal one, we infer. There could 
not have been anything very "appalling" about 
them. But how has it been with other practi- 
tioners? What can they say? I recently in- 
quired of a few physicians who happened to fall 
in my way— Dr. Traill Grreen, of Easton, Pa., 
long time in practice ; Dr. John T. Carpenter, 
of Pottsville ; Dr. Nutt, of Williamsport— several 
physicians, members of the Montgomery County 
Medical Society, who have been in extensive 
practice from twenty to forty years — and not one 
of them had ever lost a case from post-partum 
hemorrhage. Indeed, I have, thus far, not found 
one man to report a single fatal case. Some years 
ago a physician in Philadelphia, who had been 
sixteen years in a heavy obstetric practice, said 
he had never lost a single puerperal woman ; and 
Dr. Green informed me, but yesterday, that a 
former practitioner of Easton, who continued 
practice until he arrived at a great age, told him 
that he had never used the forceps, and never lost 



a woman in labor. Of my own fifty years' expe- 
rience I will not now speak. 

Is uterine hemorrhage more frequent and more 
dangerous now than it was twenty or fifteen years 
ago ? If not, why so much alarm sounded in the 
ears of students ? Why are they so strongly urged, 
in order to prevent its occurrence, to deliver the 
placenta as quickly as possible after the child has 
come away ; to make pressure, without intermis- 
sion, over the womb, in all cases ; to stay with the 
woman, not only an hour or two, but, as recom- 
mended by Dr. T. G. Thomas, from one to twelve 
hours ; to flood the womb after every labor with 
water at the temperature of 110° Fahrenheit; to 
have ice and iodine, lemons and solution of salts of 
iron, a vaginal syringe and a cruet of vinegar on the 
table by the bedside ? These things do not seem to 
be necessary if in twenty- eight years an obstetrician 
like Dr. Wilson, practicing in a great city like 
Baltimore, never had but two cases that were even 
troublesome ; not one that was alarming save the 
last — and there he needed, to relieve it, only his 
finger nails ; why then use pressure and friction, 
and injections of warm water, in every case'? 
Why thus alarm the woman and the attendants, 
who see this fear and anxiety on the doctor's face, 
and in his hurried and vigilant manner ? 

If dangerous hemorrhages are more common 
now than formerly, and I fear they are, and if 
the hemorrhage depends on uterine inertia, as the 
assembled gynecologists decided, then what is the 
cause of that inertia ? 

The length of this paper compels me to defer 
thoughts on this subject until you have room for 
another paper. 



THE PHYSIOLOGICAL CURE OF HEMOR- 
RHOIDS. ^ 

BY J. T. EVERETT, M.D., 
Of Sterling, Illinois. 
The first ten cases are not reported to illustrate 
any originality of treatment, but to contrast the 
results with those of more recent dates. The 
vein walls are composed of three coats, an inner 
epithelial, a middle fibrous and an outer areolar 
coat. In the hemorrhoidal plexus, this middle 
coat, from the constant force brought to bear 
upon it by the column of blood which it has to 
return into the vena cava, becomes thickened and 
almost muscular in appearance. The accidental 
discovery of this semi-muscular condition led 
me to make an extended examination of various 
specimens of vein walls from the hemorrhoidal 
plexus, and the result was, that in a great ma- 
jority of the cases of chronic piles this condition 
of things prevailed. 



Feb. 15, 1879.] 



Communications. 



137 



The establishment of this rule suggested the 
hypodermic use of ergot to produce contractions 
and absorption of adventitious tissue; on the 
same principle as we would use the same agent 
in fibroids ; the physiological cure seeming 
to be much preferable to the radical treatment 
by caustics, the ligature or the ecraseur. 

The result is manifest in the symptoms and 
course of the following cases: — 

Case 1.— C. C. G., aged 48, had been afflicted 
with piles for several years ; had tried all the 
•ointments and pile cures extant. Found pro- 
jecting, externally, a tumor the size of a hen's 
egg. With hypodermic syringe punctured three 
of the most prominent lobes, and threw into each 
5tt\^ tr. ferri chloridi. The pain was agonizing 
for some hours, producing considerable nervous 
^hock. 

Upon the third day the sloughs came off, leav- 
ing a healthy granulation, which healed kindly, 
leaving a broad cicatrix with great induration in 
surrounding tissues. 

Case 2. — Mrs. A. M. consulted me with refer- 
ence to a hemorrhoidal trouble induced by retro- 
version. This was first remedied in the usual 
manner ; then four of the most prominent hemor- 
rhoidal lobes were each- treated with 5Tt\^ injec- 
tions of half strength tr. ferri chloridi. Pain not 
as intense as in Case 1. Slight nervous shock 
and prostration ; patient confined to her bed for 
some days; the blackened, shriveled tumors 
dropping off on the sixth day, leaving granulating 
ulcer which healed slowly. One week afterward 
two internal lobes were exposed and treated in 
the same manner, with less satisfactory results, 
taking six weeks for them to heal. 

Case 3. — C. H. W., laboring under an acute 
attack of hemorrhoids. Gave hypodermic injec- 
tion of Sttl of a solution of equal parts of tr. ferri 
chlor. and aqueous ergot. In this case the pain 
was extremely intense for about six hours, ac- 
companied by extreme nervous shock, with 
rigors, followed by high fever. These symp- 
toms responded to morphia and quinine, and 
after three or four days convalescence followed, 
with no untoward symptoms. 

Case 4. — C. N. R. consulted me July 30th, 
1874, in reference to troublesome hemorrhoids 
which had been annoying him for some time. 
Injected five lobes of the vein with equal parts 
tr. ferri chloridi and aqueous ergot, but the pain 
was so intense and the shock so alarming that I 
despaired of making a reputation as a pile doctor 
with this remedy. The internal lobes were next 
treated with pure tr. ferri chlor. , under ansesthe- 
£ia, with satisfactory results. 



Case 5.— May 21st, 1875, S. B. , troubled for 
years with both internal and external hemor- 
rhoids, which I had treated in 1874 with good 
result; again returned with exaggeration of trou- 
ble. Treated the two larger lobes with elastic 
ligature, with good effect upon the tumors, but 
the patient was confined to his room for twelve 
days. 

Case 6. — M. S. H. had been troubled with 
bleeding piles for twenty years ; attempted first 
to destroy the protrusion with galvano- cautery, 
but the battery being deficient in power it only 
coagulated the external tissue; then injected 
equal parts of glycerine and carbolic acid into 
three of the most prominent tumors, in doses of 
5rrL each ; the tumors turned wTiite immediately 
upon the introduction of the liquid and the slough 
came off upon the fourth day, leaving a clean 
ulcer, which healed quickly. The upper lobes 
were now brought down and treated in a similar 
way, with but little comparative pain, no shock, 
no chill. 

Case 7.— June 30th, 1876, S. M. Treated 
seven lobes of protruding hemorrhoids at three 
sittings, with the carbolated oil; pain sharp at 
first, but in a few seconds subsiding ; patient 
around most of the time ad interim ; recovery 
perfect. 

Cases 8, 9 and 10 were treated in the same 
manner, with like results, the pain not being se- 
vere and only continuing for a short time, and a 
healthy slough following, leaving, upon recovery, 
in every case, a hard cicatrix, which I did not 
like, as it had the appearance of a bungle. 

Case 11. — In this case I decided to use ergot 
instead of carbolated oil, therefore threw 5Tt\, 
solution aqueous extract of ergot into the four 
most prominent lobes of the vein. The pain at 
first was sharp and burning, but this subsided in 
a few minutes, and after the lapse of 20 or 30 min- 
utes there was set up a sensation of constriction 
in the parts, which continued for several hours. 
Upon the patient's presenting himself the next 
day the injected lobes presented the appearance 
of a blackened mass, hard and dense, and con- 
tracted to one-half its original size. There was 
no systemic disturbance whatever, and only a 
disagreeable sensation of constriction in the parts. 
There was no sloughing, and the tumors gradu- 
ally subsided until they disappeared entirely, and 
the other lobes were much lessened in size. Upon 
the tenth day three of the remaining lobes were 
injected, with a similar result. 

Case 12. — S. G. ; was treated by my partner. 
Dr. S. W. Gillespie, in the same manner, with 
even better success than in my case, the patient, 



J 38 



Hospital Reports. 



[Vol. xl, 



a house carpenter, going to work the day follow- 
ing upon a building, and experiencing no diffi- 
culty ; three lobes were injected at the first and 
only sitting, and a perfect cure resulted. 

Case isl^— H. B. F., farmer, Aug. 14. This 
being quite an exaggerated case, we determined 
to try (as we had aplenty of material) the differ- 
ent kinds of injection and compare results : 
Therefore, injected three lobes with tr. ferrichlor. 
gtts. 3-5 in each lobe ; pain marked, and shock 
great, and as patient was very nervous, gave an 
opiate and applied an opiate ointment ; on the 
fifth day patient returned; injected an equal amount 
of tr. ergot and tr. ferri. chlor. This produced 
agonizing pains which were very persistent, but 
they finally subsided under the influence of the 
electric current. Upon the third visit, the pa- 
tient, having a wholesome respect for our treat- 
ment, desired an anaesthetic, which was accord- 
ingly given, and three more of the lobes injected 
with carbolated glycerine in equal parts. Upon 
recovering from the ansesthesia there was no pain 
and but little soreness followed, until the second 
day, when the ulcer came off; this healed more 
readily than the results of the other two treat- 
ments. One week from this time patient re- 
turned and we anaesthetized and injected four 
tumors with fl. ext. ergot. The pain commenced 
some hours after treatment and persisted for 
some time, but no ulceration followed. 

Case 14. — M. L. B., female; retroversion. 
After correcting the uterine pathology, the hem- 
orrhoids, four in number, were injected with fl. 
ext. ergot, with the happiest result ; no slough, 
no shock, and but slight pain, except the heavy, 
dragging sensation in the rectal region, which 
gave but little trouble. 

Case 15. — L. M., female ; retroversion severe. 
Injected two lobes of the vein with 5tt\^ aqueous 
ergot, replacing the retroverted uterus. Pain 
heavy and dragging for three or four days, since 
which time all pain has disappeared. Shall now 
proceed to the treatment of the version, which I 
hope to remedy without further trouble from the 
piles. Not since fully recovered. 

Case 16. — S.M., female; no uterine displace- 
ment. Treatedtwo external lobes of hemorrhoids, 
and three internal, with aqueous ergot, with the 
happiest results. Sharp pain at time of injec- 
tion, and heavy, bearing-down pain in rectal re- 
gion. Radical cure, with no sloughing. 

Case 17. — B. K., female ; three lobes of pro- 
truding hemorrhoids treated at one sitting by 
injecting aqueous ergot. Sharp pain at time, 
which soon disappeared, and entire recovery 
followed. 



Cases 18, 19 and 20 are simply a repetition of 
the previous ones, with like favorable results. 



Hospital Reports. 
pennsylvania hospital. 

CLINIC OF PROFESSOR DA COSTA, FEB. 1, 1879, 
REPORTED BY FRANK WOODBURY, M.D. 

Gentlemen: — I shall first show, this morning, 
a few cases illustrating the treatment of diseases 
that you will more frequentl)"^ encounter in jirac- 
tice, before bringing before you, as I intend to do 
presently, one or two cases of disorder of the 
nervous system, for clinical study, that will require 
more careful analysis and extended discussion. 

Chronic Pleurisy with "Fffasion. Ihe Question of As- 
piration influenced by Lung Complication. 

John D., 39 yeajs of age. This man has been 
in the ward for some time. The history of the 
case is that of an acute lung trouble, following 
exposure on the wreck of the steamer Metropolis, 
February 2d, 1878. When I first saw hira, in 
November last, I found that there was evidence 
of old-standing pleurisy, with some effusion on 
the right side, complicated with commencing 
abscess in the upper part of the lung. Subse- 
quently the signs of pleuritic effusion developed 
themselves more decidedly; while the absence of 
vocal fremitus, and of respiratory sounds, at the 
lower part of the right chest, with a line of dull- 
ness nearly on a level with the spine of the scapula, 
made it evident that the pleural sac now con- 
tained a very considerable amount of fluid. In 
the compressed lung, above the line of effusion, 
there was jerking inspiration, prolonged and 
harsh expiration, and a few crepitant rales ; the 
percussion note was of a higher pitch than nor- 
mal. At the left apex there was moderate dull- 
ness posteriorly, and expiration was also pro- 
longed and high pitched, but the base of the left 
chest was clear on percussion, although ausculta-: 
tion again revealed exaggerated breathing and 
blowing expiration. He had considerable mucous 
expectoration, and coughed very much during 
the day, and also at night. 

The question presented itself to our minds, 
should we introduce a hollow needle into the base \ 
of the chest and withdraw this fluid by pneumatic 
aspiration? Upon thinking the case over, as there 
was strong evidence of pneumonic phthisis in the 
lung itself (although masked by effusion), and 
finding, moreover, that there was no marked irri- 
tative fever, and no other good reason existed 
for _ supposing that the chest was full of pus, I 
decided to wait, and in the meantime try what 
advantage could be gained by medical treatment 
alone. The latent phthisis, and the want of ac- 
tual knowledge that the effusion had become 
purulent, made me deem it more desirable to 
remove it by medical means if possible, rather 
than by a surgical procedure ; I therefore decided 
not to tap him, and the result has justified this 
conclusion. 

Listening to the heart I find a soft systolic mur- 
mur, modifying the first sound, which is heard 
most distinctly at the base of the heart to the left 



Feb. 15, 1879.] 



Hospital Reports. 



139 



of the sternum. It is a blood murmur, and not 
organic. There is still dullness at the lower part 
of the right side, but it is very low down ; for I 
can hear the transmitted voice everywhere ex- 
cept at the very lowest part of the chest ; the 
vocal fremitus has also been restored. Another 
evidence of the diminution of the effusion is per- 
ceived in the fine friction, which is now return- 
ing, and can again be heard at the base of the 
lung. The chest expands well, and respiration 
is heard in the area that was formerly dull, under 
the angle of the scapula. This is a very gratify- 
ing result. Two months ago his condition was 
a very different one. The large amount of fluid 
then existing has almost entirely passed away, 
while his general physical condition has greatly 
improved. 

His treatment has been as follows : — 

basham's mixture. 

R . Tincturse ferri chloridi, Tr^x 
Acidi acetici, V(\jv 

Alcoholis, f. 3 ss 

Syrup., f.^j 
Aquge, TTLxlv 

Liq.ammonii acetatis. f. ^iss. M. 

Given three or four times daily. 

This is the formula of a diuretic that I often 
use, and which I have frequently referred to under 
the name of Basham's mixture, in prescribing 
for cases where I desired a tonic as well as a diu- 
retic action. The patient has also had, occa- 
sionally, a Dover's powder, to keep up a gentle 
action of the skin, as well as for the object of re- 
lieving his cough. This internal treatment, with 
good diet and rest in bed, and the application of 
tincture of iodine to the chest, has given us these 
good results. It is evident that we should con- 
tinue the treatment, as it agrees with him and he 
has received from it so much benefit. He shall 
take the mixture four times a day, and flying 
blisters shall be occasionally used over the affected 
lung. Keeping in mind the latent tubercular ten- 
dency, I shall also give him half-an-ounce of cod- 
liver oil, three times a day. 

Of course it is no longer necessary to discuss the 
practicability of aspiration ; this question has set- 
tled itself. This case teaches an important lesson : 
In cases of pleurisy, with effusion, v/hen aspiration 
is under consideration, there can be no harm in 
waiting, if there are no urgent symptoms caused 
by pressure on the lung, and in the absence of 
irritative fever, furnishing evidence of the fluid 
becoming purulent ; I would, therefore, lay down 
the following rule : In regard to the time for the 
performance of aspiration^ you are to he governed 
by the effect rather than by the time or amount 
of the efusion. If we had been guided by the 
time in this case, we should have tapped the 
chest when I first saw him, for the eflPusion had 
then existed several months, and was increasing 
rather than diminishing. 

This is one point. Another that I would like to 
direct your attention to is the mode of treatment 
by counter-irritation, and by Basham's mixture. 
Iron in this form is one of the best remedies that 
I can think of in chronic pleurisy, and from it 
I have had most favorable results in a number of 
cases. It produces no disturbance of digestion 



nor of the circulation, but, on the contrary, greatly 
aids the blood-making function. 

The possibility of the tubercular complication 
was an additional reason for preferring medical 
to surgical means for removing the fluid in the 
present case ; knowing that any active interfer- 
ence of the kind would be very apt to excite fresh 
deposit in the lung itself. When the effusion ia 
thus removed, as a rule, it rapidly returns, but if 
absorbed under the action of diuretics the disease 
is less likely to re-appear. Moreover, I have 
noticed in several cases, that after aspiration, es- 
pecially if it should be repeated several times, 
there is a tendency in the subsequently effused 
fluid to become purulent, forming empyema, with 
its attendant chills and hectic fever. This case 
will serve to show you that surgical methods 
should not be resorted to until you are certain 
that medical means will not answer, or unless 
the urgency is great, and the demand for imme- 
diate relief is imperative. 

Typhoid Fever. Ilements of Prognosis in Jlbumi- 

nuria, and the State of the Heart. Rational 

Treatment. 

I will now bring before you a case of typhoid 
fever, and hope to show you that the interest in 
a case of typhoid fever does not cease with the 
diagnosis. 

This patient, Henry F. B., 23 years of age, 
came into the Hospital Jan. 27th, 1879, with the 
statement that he had been Avell until the 23d of 
the month, when, following, as he thought, "some 
slight exposure," he had chilly sensations, fol- 
lowed by fever and great prostration. His bow- 
els were rather loose, and he had several attacks 
of epistaxis. He came into the ward with symp- 
toms of a continued fever, very like those of ty- 
phoid, and he complained of severe pains in his 
back. It was observed that his face was singu- 
larly flushed, and the skin was hot and dry 5 
tongue coated. The temperature in the axilla 
was high (104J°), the pulse was 92, and the res- 
pirations 24 to the minute, respectively; and 
what was very significant, we found nothing in 
the lungs to account for this flushing of the face. 
Upon this point I intend to speak further, and 
shall presently return to it. 

Upon examining the urine, after admission, it 
was found to contain granular, hyaline and epi- 
thelial casts, and a small amount of albumen. 
This examination of the urine has been repeated 
in the last few days, with identical result. 

Now, gentlemen, the man during the short 
time intervening since his admission has re- 
mained in the condition that we have described, 
with some morning remissions in his fever and 
with marked evening exacerbations. A few bron- 
chial rales were detected in his chest, but no 
dullness nor signs of consolidation. On the 28th 
he again had a profuse epistaxis, and on the 
same day an eruption of rose-colored spots ap- 
peared on the abdomen and chest. The fever 
persists, the belly becomes swollen : still he has 
no headache. Having given you these points in 
the case, which brings it up to this morning, I 
will examine him before you. His temperature 
last night was 103°, this morning 102^. Since 
the 28th there has been very little difference 
between the evening and the morning tempera- 



140 



Hospital Reports. 



[Vol. xl 



ture, not moi'e than a degree, while the evening 
observation continues to be high. The fever 
shows a continued type, and the record corres- 
ponds with that of typhoid in its second week. 

Notice the appearance of the patient's tongue. 
If you should want to select a characteristic 
typhoid fever tongue, there it is. Dry, cracked, 
red, devoid of coating at several points, clean at 
the edge, with a wedge of coating at the tip. I 
could never give you a better illustration of the 
dark, glazed, red tongue of typhoid fever than the 
one before you. 

Turning to the abdomen, we find here the 
characteristic eruption, but, in truth, the most 
typical spots are on the sides of the chest rather 
than on the abdomen. They are small, rose- 
colored, slightly raised, and the color temporarily 
disappears upon touching them with the finger. 

Some gurgling is elicited upon pressure, in the 
right iliac fossa, and there is a moderate amount 
of general abdominal distention. The bowels 
are now moved once daily, but in this con- 
nection it should be stated that on the day 
before yesterday he had four stools, and it 
was thought advisable to give him an opium 
suppository; since then his bowels have been 
regular. His diarrhoea, then, is easily held in 
check, for under the influence of one grain of 
opium, which was not repeated, he has now had 
only one movement in the twenty-four hours, for 
several days. You perceive that his face is 
still flushed, and you may also note that he has 
some harsh breathing in the lungs, with a few dry 
rales. He has no headache, and what I wish 
particularly to call your attention to is, that his 
intelligence is clear. 

But one or two points more, and I will have 
finished whatl wished to tell you to complete the 
clinical record. Examining the heart, I find that 
the first sound is iveak, and the impulse is not 
strong ; the second sound is distinct. The final 
point to which I will direct your attention befoie 
dismissing the case is — what you can see for 
yourselves — that there is marked throbbing of the 
vessels at the root of the neck. 

This is a typical case of typhoid fever, coming 
under observation at its very beginning, but which 
has now reached its height. I will merely pause 
to point out a few peculiarities that serve to sepa- 
rate this from an ordinary case of typhoid. 
_ In the epistaxis, the diarrhoea, the fever con- 
tinuous after the fifth day, the character of the 
eruption — in none of these do we have anything 
differing frorn a typical case. But here is a point 
of great significance. The albumen in the urine, 
what does it mean ? It means that we must watch 
this case. Albuminuria in the first week of ty- 
phoid fever can only be explained on two grounds 
—the complication antedated the fever, and is due 
to antecedent kidney disorder ; or it is an evidence 
of serious blood alteration due to the fever pro- 
cess itself, and secondarily giving rise to the ab- 
normal elements in the urine. Kidney disorder 
is occasionally produced early in typhoid fever, 
but in this event you should bear in mind that 
you will have a very grave case. Referring to 
the history, it is seen that our patient is only at the 
beginning of his second week. The eruption also 
tells us that the disease is no further advanced 
than the period just stated. The albumen and 



renal casts were recognized on the second day of 
his stay in the ward, or the fifth day of the illness. 
Early albuminuria never happens intyphoid fever, 
unless the case is going to be a very gi-ave one. 
This is a point of prognosis worth bearing in 
mind, it being understood that the condition 
belongs to the typhoid fever process, and not to 
any antecedent disease of the kidneys. By it 
we learn that there is a degree of blood involve- 
ment that should not exist at this stage of the 
disease ; such a condition is more likely to be 
met with in the third week than at the beginning 
of the second, and it makes us anticipate the 
worst consequences. There is nothing peculiar 
about the temperature in this case, except that 
it was quite high on the evening after admis- 
sion, 104:1, and has scarcely attained that point 
since, the highest being lOS^-. 

There is another point to which I would call 
your attention, and it also leads me to believe 
that the case is likely to be a serious one — it is 
that the first sound of the heart is altered. Such 
changes in the muscular fibre of the heart as 
this indicates are not uncommon in typhoid fever, 
but they do not generally occur until late in the 
malady. When it appears early, it shows you 
that you are going to have a grave case. By 
these two symptoms I have described you have 
due warning of the approaching danger, and they 
tell you that you Avill need to exert all your skill 
to avert it. 

I must also speak of the flushed face, unac- 
companied by pneumonia. This should always 
make you suspicious, especially when associated, 
as it is here, with throbbing of the vessels of the 
neck. Some years ago this condition of the ves- 
sels in the early part of the disease attracted my 
attention, and I framed upon it a means of ready 
diagnosis. In walking through the wards I would 
often recognize an early case of typhoid fever by 
this means alone, before inquiring into the his- 
tory of the patient. Sometimes I was strikingly 
correct, though I must admit that I was wrong in 
other instances. I would mention it as one of 
the significant symptoms of early typhoid fever. 

I have now developed some of the important 
features presented by this case, and predict that 
from its consideration, notwithstanding the clear- 
ness of the patient's mind, the easily controlled 
diarrhoea, and the absence of nervous symptoms, 
we are going to have a severe case of disease. 
Should we not guide our treatment accordingly? 
Yes, and I have, therefore, departed from my 
usual rule of not giving stimulants early in ty- 
phoid fever, and ordered him, on admission, three 
ounces of whisky, in milk, during the day. This 
shall now be increased to five ounces, some being 
given during the night. He is also taking 

R. Acid, muriatici, gtt.x, 

in water, every four hours. 

When first admitted he also had some quinine, 
which we shall now continue as a general tonic, 
ten grains being given through the day. This, and 
the increased stimulant, are required by the 
weak first sound of the heart. He shall have 
only beef tea and milk for his diet. No opium 
at all will be given, except as we have done, in 
the form of suppository, and that only in case 
the diarrhoea should become troublesome. He 



Feb. 15, 1 879. J 



Hospital Reports. 



141 



shall be sponged morning and evening, and shall be 
watched carefully, so that he may not leave his bed 
during the night, while in a state of delirium. 

Multiple or Disseminated Sclerosis, Following Spinal 
Meningitis. Its Clinical Features and Treatment. 

I now wish to show you two cases of interest- 
ing spinal disorder ; the first patient being now 
brought before you. Although we begin with 
this one to-day, I fear that we will not be able to 
finish the discussion of both of them until our 
next clinic day. 

Joseph J., 43 years of age, is a watchmaker. 
He comes from a long-lived family, his father 
dying at the age of ninety. The patient states 
that with the single exception of bleeding piles, 
which began to annoy him some eight or ten 
years ago, he has always been a healthy man, 
until his present illness. Syphilis he never had, 
at least he utterly denies any remembrance of it. 
He tells us, however, that about five years ago 
he began traveling about the country in a Avagon 
and on horseback, and was much exposed to all 
weathera, but until about three years ago this 
exposure did not affect him particularly, except 
that he noticed that, occasionally, he had cramps 
in the calves of his legs. At the time named the 
cramps were more marked, and now became as- 
sociated with numbness in the right foot ; indeed, 
the disorder of sensation soon involved both 
lower extremities ; nor was it confined to them, 
for the first three fingers of the left hand became 
similarly affected about the same time. Remem- 
ber, that this man had been exposed to cold and 
wet, and, notwithstanding these cramps, he kept 
on riding through the country, and continued to 
encounter all kinds of weather. Soon after this 
we notice more marked symptoms appearing on 
the scene. But first let us return, for a moment, 
to the beginning of the third year, to notice that 
he also had difficulty in retaining his water about 
this period, so that his urine was dribbling nearly 
all the time. His piles also troubled him a good 
deal during the year. Following this, a new set 
of symptoms are observed in the case. Those 
I have just read to you from the notes may be 
called the symptoms of the first year of the mal- 
ady. Now comes the second year. At the be- 
ginning of this period we notice a loss of power 
in the legs, his ankles are weak, his feet turn 
under him, he frequently stumbles in going over 
rough ground. There is some inability to con- 
trol muscular motion in the lower extremities; 
and when he gets out of his wagon to lead 
the horse up a hill, he often falls. He now also 
observed twinges of pain in the legs, though only 
of short duration, never keeping him awake at 
night. They were occasionally accompanied by 
muscular twitchings, which, though also occur- 
ing in the arms, were more marked in the legs. 
He also speaks of a sensation as of a cord drawn 
around his waist, which impressed him so much 
that he thought he was swelling, and often loos- 
ened his clothes, and took quantities of medicine 
for flatulence, but to no avail. 

During all his illness he has had no pain in his 
spine, and none in the head, except a very little 
in his eyes, but his sight has failed so much that 
he is compelled to use spectacles. He occasion- 
ally has a little vertigo. 



About eighteen months ago, attributing his 
trouble to the piles, he had them removed, but 
without any marked effect upon the nervous 
symptoms. The incontinence of urine was not 
relieved, but became worse ; and, in truth, it 
was for this symptom alone that he sought ad- 
mission into the hospital. Only after he came 
under observation did we learn of the existence 
of his other troubles, an^ that the incontinence 
of urine was only a very small part of the malady. 

Now, this man can only walk, if indeed we can 
say that he walks at all, by the aid of crutches. 
T wish you to look at his legs. You will see for 
yourselves that they are atrophied ; the left being 
decidedly more wasted than the right. You 
further notice that there is a good deal of mot- 
tling of the surface, and congestion of the veins, 
seen in both feet nearly alike. He has suffered 
very much from cold feet for the last two years, 
and has used liniments and capsicum without 
any effect. Since he has been in bed, however, 
his feet are warm enough. Testing sensation, 
you observe, when I pinch the feet, and when 
I use the pin, both on the dorsum and soles 
of the feet, how defective the sensation is ; he 
hardly notices it. There is greatly diminished 
sensibility in both legs ; he does not feel tickling 
at all. Evidently, the reflex movements are not 
quite abolished, but although reflex contraction 
occurs, it is slow, and not very active. If the sensa- 
tion were better, I have no doubt that the reflex 
movements would be more energetic ; it is, pro- 
bably, as good as we could expect with such im- 
paired sensibility. 

He has considerable motion in the muscles of 
the legs as he lies in bed ; you see that they are 
not entirely paralyzed, but he cannot use them 
in walking, except with the aid of crutches. 
Therefore, while muscular motion persists, it is 
the control of the muscles in coordinated move- 
ments that is mainly disturbed. You will ask, 
does a similar state of affairs exist in the arras? 
We find that sensibility is also diminished, though 
to a less degree, in the upper extremities, but all 
the motions are preserved, though the grasp is 
comparatively feeble. He says that he can thread 
a needle and use his fingers without difficulty. 
Therefore, the same defect in sensibility and 
motor power exists in the arms, but the power 
of coordinated muscular movement is not nearly 
so much impaired in the arms as we find it was 
in the legs. 

I will now show you the result of the examina- 
tion of the muscles by the battery, using the 
Faradic current. The muscles of the thigh quiver 
on the right side with a slowly interrupted, 
strong current, but it takes a still stronger current 
to make them contract. The muscles of the thigh 
and leg move with a strong current slowly inter- 
rupted. In the left thigh the phenomena are less 
marked, and a stronger current is required to 
produce the same effect. Therefore, the electro- 
muscular contractility under this current is 
shown to be much impaired, but it is not so much 
impaired as the electro-muscular sensibility. 
Using a quickly interrupted current, we find it 
produces only a slight quivering under a very 
strong current. The rectus muscle of the right 
side may be made to move, but only under a 
strong current ; the same observation applies to 



142 



Hospital Reports, 



[Vol. xL 



the left, but witli the difference before remarked 
in favor of the right. 

In the arms, you perceive that while muscu- 
lar motion is preserved, the muscles of the limbs 
are greatly reduced and weakened, so that the elec- 
tro-muscular contractility is materially altered ; 
still, not nearly so much as in the legs. He tells 
us that he feels this current distinctly in the arms. 
The sensibility is then preserved, but like the 
contractility, it is also slightly impaired, and to a 
far less degree than in the legs. 

In conclusion, I will call your attention to the 
muscular quivering which is now taking place in 
the lower extremities, irrespective of the battery. 

The eyes have been examined, with a negative 
result. There is no disease of the heart. 

I will not have time to conclude the discussion 
of this case this morning, butwill merely announce 
the diagnosis, and give you the reasons for it at 
my next clinic. It is a case of sclerosis of the 
spinal cord, the hardening existing in different 
portions of the structure, and affecting them un- 
equally. It has undoubtedly involved the pos- 
terior columns, and the antero-lateral columns, 
also, though to a less extent, the anterior columns 
in the dorsal region. Neither of these regions 
is intact. It is sclerosis, then, of several por- 
tions of the cord, secondarily induced, and fol- 
lowing and consequent upon congestion of the 
cord and spinal meningitis. 

His treatment has been the bichloride of mer- 
cury, one-thirtieth of a grain thrice daily, which 
shall now be increased to one-fifteenth of a grain, 
and subsequently to a larger dose, provided he 
bears it well. He has also been taking a little 
strychnia, occasionally, for his bladder trouble, 
but the chief dependence has been upon the 
bichloride. 

_ The hour having expired, I will continue the 
discussion of this, with the other spinal case, at 
our next meeting. 



NEW YORK HOSPITAL. 

DISEASES OF THE SKIN. 
BY L. DUNCAN BULKLEY, M.D. 

Reported for the Medical and Surgical Eepoktee. 

{Concluded from p. 123.) 

Acne. 

On the face of this young girl there are three 
forms of the eruption known as acne, viz., acne 
punctata, acne simplex, and acne indurata. The 
first, acne punctata, is also called comedo, and 
is manifested by the little black spots which you 
see scattered over the surface, and consists merely 
in a blocking up, or a constipation of the seba- 
ceous follicles. The acne simplex is character- 
ized by the papules and pustules, and the acne 
indurata by these larger, indurated masses, which 
contain pus, and which are made up, not of single 
glands, but of groups of glands. We might add 
to these varieties still another form of the affec- 
tion, observed over most of the face, viz., acne 
oleosa, the presence of which is indicated by the 
greasy condition of the face. 

For the treatment of comedo the best method 
is the employment of a small silver tube, such as 
I hold in my hand, which is made for the pur- 



pose, and which acts in the same way as the or- 
dinary watch key, so commonly used in the affec- 
tion. It is, as you see, about two inches long,, 
and about one-eighth inch in external diameter, 
with its ends hammered over, leaving an aper- 
ture of about one-twenty-fifth of an inch at one 
end, the other a little larger. It is much preferable 
to a watch key, in that the round end does not 
cut the skin, as the square -cut end of the former 
may do, while the rounded, or rather conical ex- 
tremity, when pressed into the skin, rather serves 
to stretch open the orifice of the gland, and to- 
favor the extrusion of the plug. Thus, when I 
press it upon the surface surrounding one of 
these little black points, the plug instantly rises 
up into it, and you may soon see a number of the 
little masses standing like minute horns on the- 
surface. It is very efficient, and easy of applica- 
tion, and does not occasion the patient any pain 
to speak of. In my office I have frequently re- 
moved from fifty to a hundred of these plugs at 
a sitting, and have occasion to use the instrument- 
many times in a day. 

For the local treatment of the indurated lumps, 
opening with the knife is the only efficient means, 
and the earlier this is done, the less danger there 
will be of permanent scarring. When thej'- are 
left to themselves, scarring almost invariably re- 
sults ; and some time ago I exhibited at the Aca- 
demy of Medicine a patient whose face had been 
so marked and disfigured in this way that many 
of the gentleman present could scarcely be per- 
suaded that he had not had the small-pox. The 
best instrument for making the incision is the 
ordinary thumb lancet, as with a moderate pres- 
sure it only punctures to the depth of the follicle. 
When I now open one of these lumps, you per- 
ceive what a large quantity of matter they really 
contain. For the rapid cure of the papules and 
pustules of acne, each one of any size should be 
punctured with a lancet ; or I have at times em- 
ployed with advantage a method v/hich is much 
used in Vienna, which is, to scrape them thus, 
with the dermal curette, and it is certainly very 
efficient ; only the top of each pustule ' is re- 
moved, a drop of blood or serum exudes, and no 
scar is left. This, then, is a very good exam- 
ple of acne, as it is frequently presented to you 
in a mixed form. 

Let us now dismiss our patient and look a little 
more particularly into the different subdivisions 
of the affection. Acne oleosa, which we have 
seen to be present in this patient, is a variety of 
what is known as acne sehacea, which is divided 
into acne oleosa, acne sicca, acne cornea, and acne 
exsiccata. It is acne sicca when it dries up into 
a thin crust, which differs from that formed in 
eczema, in that it is greasy. Such a crust 
can readily be rolled up into a ball. Such a con- 
dition is well shown in this colored plate of Wil- 
son's. When it becomes harder, the affection is 
known as acne cornea ; and when the follicles 
refuse to act, and the skin gets too dry, acne 
exsiccata. - 

Acne punctata has been divided into two va- 
rieties, viz : acne nigra, or comedo, and acne 
allida, or milium. It consists, as we have seen, 
in a plugging up of the glands, a real constipa- 
tion, which may be forcibly compared to consti- 
pation of the intestine. When the point of the 



Feb. 15, 1879.] 



Hospital Reports. 



143 



plug at the surface is black (from the accumu- 
lation of dirt, etc.), it is called comedo. Milium 
represents thac condition seen principally be- 
neath the eyes, when there are small white 
specks, whose sebaceous contents are contained 
beneath the epidermic covering, and cannot be 
exposed until a slight puncture is made. If we 
examine the state of one of the plugs from acne 
punctata nigra, or comedo, under the microscope, 
we find masses of altered cells from the interior 
•of the gland, some oily matter, and a few hairs. 

The ordinary secretion of the sebaceous glands 
occurs from fatty metamorphosis of these cells; 
but in acne punctata these fail to undergo this 
metamorphosis, and concrete into these cheesy 
masses. In the glands a parasite is sometimes 
found, in the form of a minute worm, the acarus 
or demodex folliculorum ; but is of no import- 
ance in connection with any disorder of their 
function, and you understand, of course, that it 
is excessively minute, many being sometimes 
found in a single follicle ; their existence has 
probably aided in giving to these sebaceous plugs 
the popular name of worms or grubs. In acne 
simplex the lesion is a simple inflamed pimple, 
and these pimples occasionally cover the whole 
face, or are lightly scattered over it ; sometimes 
they are seen over the whole back, as in the 
plate and photograph which I now show you. 

Acne indurata, as we have seen, consists of a 
number of elevations of the skin, which are much 
larger than those of acne simplex, very indolent, 
generally painless, always containing pus, and 
sometimes in considerable quantity. They are 
of a deep purplish-red color, and are apt to last 
a long time. Every comedo that is removed, I 
may remark, in passing, lessens the chance of 
the patient's having some of the other lesions of 
acne, inflammatory in character. 

Acne molluscum, whose true nature has been 
the source of considerable dispute, has been 
shown, beyond doubt, I think, by the more re- 
cent writers, to be a sebaceous disorder. It is a 
■disease which resembles comedo, in that it is 
characterized by an alteration of secretion, and 
hardening about the sebaceous glands; but in- 
stead of being located in or under the skin, as come- 
do, the small tumors constituting the affection pro- 
ject above the surface. Its small pearly tubercles, 
generally of the normal flesh color, or white, flat 
on top, generally with one or more minute open- 
ings, have been very aptly compared to a small 
button, and are so well shown on these colored 
plates, which I will pass around, that I need 
ihardly describe them further. They are far more 
commonly met with on the face, but you see by this 
photograph that they may occur on any or all 
parts of the body. It is a purely local disorder, 
and anything that will remove the glands them- 
selves will cure it. They can often be snipped 
off with the scissors, or they are readily enucle- 
ated, after a slight incision ; it is safer always to 
burn the face with nitrate of silver. Acne seba- 
cea and punctata ^ however, must not be regarded 
as of a local character alone ; they are always 
associated with some disorder of the general 
health. 

Acne proper is never a purely local disease. 
When a case, in any instance, is invastigated 
thoroughly, it will, perhaps, be found that there 



is constipation, dyspepsia, or some other dis- 
order of the alimentary canal present ; and in 
females the eruption is particularly apt to be as- 
sociated with some sexual derangement. Our 
treatment, therefore, in order to be at all suc- 
cessful, must be directed toward the real cause 
of the difficulty ; and in any case of acne it is our 
first duty to enter into an investigation, in order 
to find out what that may be. For this purpose 
it is not infrequently necessary to make a 
thorough examination of the entire system. 
Tliere is one diagnostic point which may be of 
considerable service to you in this connection, 
and that is, that in females, when the acne de- 
pends on some uterine derangement, the erup- 
tion is almost invariably confined to, or prin- 
cipally seated on, the lower portion of the face. 

The treatment of acne, then, consists in the 
removal of the cause; and as you would natu- 
rally expect, under such circumstances, there is 
no one remedy for this affection. In a certain 
class of cases arsenic may do good, but in very 
many it is useless or harmful ; in some strychnia, 
and in others, phosphorus. On account of its 
special property of relieving cutaneous conges- 
tion, however, there is nothing which I have 
found of such universal application as acetate of 
potassa. It may often be combined advanta- 
geously with nux vomica and taraxacum, or 
with senna, if the bowels are constipated. Later 
on in the disease, when the inflammatory stage 
is over, good results may be obtained, very fre- 
quently, from the use of arsenic. In the acne 
indurata, cod-liver oil often yields the very best 
results. 

In the local treatment of acne many of the 
German authorities, such as Neumann and 
others, are in the habit of employing very stimu- 
lating applications, and strongly recommend the 
green soap. This, however, is altogether too 
harsh an agent to be indiscriminately employed 
in every case. What has proved of far greater 
service in my hands is the application of water 
so hot as to be almost scalding, which has the 
effect of softening the comedones and also of re- 
lieving the congestion. A cloth saturated with 
it should be held against the face for from three 
to five minutes, and then a wash, such as one of 
the following, applied: — 

R. Potass, sulphuret, ^j 

Zinci sulph., ^] 

Aq. rosae, f. ^ iv. M. 

R. Sulphur, loti, ,^ss-5J 

^theris, f. % ss 

Alcohol, q. s. ft. f.'l iv. M. 

Or a wash composed of prepared calamine 
and oxide of zinc, in the proportion of a drachm 
of each in four ounces of rose water, with from 
one to three drachms of glycerine, may be sub- 
stituted for them. 

In certain cases, however, strong stimulation 
is really necessary ; and in such cases green soap 
and alcohol, the red precipitate of mercury and 
other irritants may be resorted to. But what- 
ever the treatment adopted, it is often useless 
unless a change of habits and of diet is made by 
the patient ; for this reason traveling, or, at all 
events, a change of scene and mode of life, is 
often of very great advantage. 



144 



Periscope. [Vol. xl 

Editorial Department, 



Periscope. 



Experiments on Malignant Pustule. 

At the meeting of the Academy of Medicine, 
held on the 29th of October last, M. Colin de- 
scribed a series of experiments made with the 
view of ascertaining the means of neutraliz- 
ing different forms of virus in the organism. 
Forty rabbits were put under observation, and 
were inoculated with the virus of the "pustule 
maligne." The inoculation was done at the tip 
of the ear, which was cut off ten minutes after 
the operation. In every case the disease de- 
veloped itself, and the virus did not seem to have 
lost any of its energy throughout the series of 
experiments. In the case of seven rabbits 
tincture of iodine was the substance used to neu- 
tralize, associated with a strong portion of iodide 
of potassium; in fourteen others carbolic acid 
was used ; in four sulphuric acid was the agent ; 
in five more hyposulphite of soda; in three 
borate of sodium ; in two sulphate of iron ; and, 
finally, in the remaining five cases sulphate of 
quinine was injected. Progressive doses of from 
twelve to twenty-three milligrammes of iodine 
were injected into the veins of the first seven 
rabbits for every kilogramme of their weight, 
but they all died within twenty- eight hours from 
the time of the inoculation. Fourteen rabbits 
were injected with 230 milligrammes of carbolic 
acid for every kilogramme of their weight, but 
the one that resisted the longest died forty-two 
hours after the time of inoculation. In the re- 
maining trials with the other substances above 
named, the results were approximately the same. 
M. Davaine had found that the substances above- 
named were capable of neutralizing the virus in 
: watch-glass, but the experiments of M. Colin 
conclusively prove that their action is not the 
same in the organism. M. Colin expressed his 
regret at not having obtained more useful results, 
but still hoped to be able eventually to find some 
counter- agent for this terrible poison. In each 
case the characteristic alterations of the disease 
existed, such as swelling of the spleen and the 
presence of bacteria in the blood. 



The Etiology and Treatment of Epilepsy. 

Dr. Berger gives, in the Zeitschrift fiir Prak. 
Med., a series of observations on the etiology of 
epilepsy, which tend to illustrate the different 
experiments that have been made to produce 
epilepsy artificially. The following were the 
principal causes. A traumatic affection of the 
median nerve caused epilepsy in a man ; disturb- 
ances of the sexual organs in women had the 
same effect. (One was a case of hsemelytrometra, 
which was subsequently operated on ; the other, 
cessation of the menses, caused by a severe cold.) 
Four cases may be classed under the head of 
epilepsy, caused by injury. The patients (three 
male, one female) had sustained injuries to the 



head, either through a blow, fall, or box on the 
ear, and the disease subsequently manifested it- 
self either directly afterward, or after weeks or 
even months had elapsed, while in the meantime 
the only thing the patients complained of was 
occasional diffused headaches. The next cases 
belong to the form of epilepsy caused by af- 
fection of the cortical substance, especially in 
syphilitic persons (according to Fournier, Char- 
cot, and others). Among these, he gives a very 
full description of a case of epilepsy in a man, 
aged thirty- eight, who had been several times 
under treatment for sj^philis, and who was subject 
to epileptiform attacks that did not differ in the 
least from general epilepsy. He was cured by a 
very energetic anti-syphilitic treatment. Two 
further cases recorded describe vaso-motor epi- 
lepsy in a girl, aged nineteen, and a very inter- 
esting case of epilepsia gravior, occurring also in 
a girl aged nineteen, after poisoning with car- 
bonic acid. In the treatment of the disease, the 
author has used several methods with varying 
success. Hystero-epileptic patients were the 
only ones that derived any benefit from Chap- 
man's method of application of ice or cold water 
to different parts of the body; true epilepsy was 
never cured, either by this method or by elec- 
tricity. In vaso-motor epilepsy the constant cur- 
rent proved very useful. Some authors have 
highly commended the effects of bromide of 
camphor and bromate of zinc ; but Dr. Berger 
does not agree with them ; neither has he seen 
any satisfactory results produced by atropin and 
curare ; nitrite of amyl, if inhaled in time, some- 
times proved efficient in cutting short the parox- 
ysm. The most favorable result has been caused 
by bromide of potassium, if given in large doses 
(from six to twelve grammes, equal to one and a 
half to three drachms, daily) ; the disease some- 
times only manifested itself again after two years, 
but it never was completely cured. Bromal-hy- 
drate has a similar effect to that of bromide of 
potassium (Steinauer). 

Surgical Treatment of Anasarca. 

Dr. H. A. Wickers writes to the Lancet : The 
treatment of anasarca, whether cardiac or renal 
in its origin, after ordinary therapeutic meas- 
ures have failed, is in most instances very un- 
satisfactory. If the patient be let alone, after a 
time he gets water-logged and dies ; incisions 
nearly always lead to sloughing ; and other plans 
of treatment, such as drainage tubes, etc., have 
proved scarcely less unsuccessful. 

The following method has been in use for sev- 
eral months at Charing- cross Hospital, where it 
has been employed in some forty or fifty cases ; 
it is readily carried out, gives great relief to the 
patient, and has never been followed by ulcera- 
tion, sloughing, or inflammation : — 

The legs having been well oiled, and a mackin- 
tosh sheet placed under them, about twenty or 
thirty punctures are rapidly inade in their sides 
with a stout needle or hare-lip pin : some sponges, 



Feb. 15, 1879.] 



Periscope. 



H5 



which have been well wrung out in a saturated 
watery solution of salicylic acid, are now placed 
against the punctures, so as to absorb the fluid 
as it transudes ; these sponges, as they become 
filled, are squeezed out, and again passed through 
a solution of salicylic acid before being replaced 
against the patient's skin. In this manner re- 
newals may be required about every two or three 
hours ; and four or five pints of fluid may be 
drained away during the first day, the whole pro- 
cess being possibly completed in four or five 
days, at the end of which time the punctures are 
usually healed. By the use of salicylic acid, de- 
composition of the dropsical fluid does not occur, 
the sponges are kept free from fetor, the skin is 
not irritated, and cutaneous inflammations of a 
low type are entirely prevented. 



The Therapeutic Value of Oxygen. 

Dr. Benj. W. Richardson, of London, says 
on this subject, in a late lecture : Therapeuti- 
cally, the positive place of oxygen is, first, as an 
antispasmodic. For excesses of activity of ner- 
vous action, leading to what are called spasmodic 
or tetanic conditions of body, oxygen is a posi- 
tive remedy. It may not of necessity be in 
every such case a powerful or instant remedy, 
but whether it be powerful or not, the positive 
direction of its action as an antispasmodic is 
definite. 

In this therapeutical point of view, oxygen 
raised in temperature to 75° or 80° F. combines 
admirably with other volatile antispasmodic 
remedies, and with none so well and effectively 
as with vapor of the nitrite of amyl. In acute 
spasmodic asthma, when there is little excess of 
secretion in the bronchial tubes — that is to say, 
when the obstruction to breathing is purely from 
spasm, the inhalation of amyl nitrite in an at- 
mosphere of warm oxygen is the most immedi- 
ate of reliefs I have ever witnessed. The diffi- 
culty of administration is all, indeed, that stands 
in the way of the general adoption of this plan. 
To apply the remedies in combination, a bottle 
of compressed oxygen, or a large reservoir' of 
gas, must be at hand ; an intermediate bag for 
the holding of the gas ready for its respiration is 
next required ; the escape tube from the bag has 
to be connected with the nitrite inhaler : and, 
finally, unless it be summer weather, the tem- 
perature of the gas has to be artificially raised to 
the necessary degree, which must not be less 
than that of summer heat. 

In addition to its action as an antispasmodic, 
oxygen, at a raised temperature, is an elimina- 
tive, and that for the same reason as it is a relax- 
ant. We have here again, in this fact, a positive 
therepeutical indication for its use. In extreme 
spasmodic diseases — in tetanus, for example — 
where we want to reduce spasmodic action, and 
at the same time to eliminate freely, the use of 
oxygen stands out in the most perfect order. 
Some years ago Sir James Paget treated an ex- 
treme cast of acute tetanus, in St. Bartholo- 
mew's Hospital, by subjecting the sufferer for 
several days to the inhalation of oxygen gas. With 
the spirit, kindness, and thoughtful considera- 
tion which never desert Sir .Tames Paget, he 



was good enough to remember that the therapeu- 
tical observations then being carried out would 
be specially interesting to one who was making 
the action of oxygen a subject of experimental 
research. He therefore invited me to visit the 
patient with him, which I did. The tetanic par- 
oxysms at the time of my visit were subsiding, 
and the m^an expressed himself as greatly re- 
lieved. The most remarkable feature of his 
case, after the fact of the relaxation of the 
spasm, was the elimination that was in progress. 
The man was literally bathed in perspiration, 
and had, I learned, been so for many hours. The 
surrounding temperature was very high, and the 
oxygen, true to its course in that condition, was 
acting most usefully. It was not only relaxing 
the muscular fibre, but was causing profuse eli- 
mination. In this case the administration of the 
gas in an ordinary ward of the hospital was a 
troublesome and imperfect process. In order to 
make such administration easy, precise and per- 
fect, there ought to be in every hospital one or 
two inhaling rooms, in which the patient could 
breathe, without the impediment of an inhaler, 
any atmosphere the physician or the surgeon might 
wish to prescribe, and at any temperature he 
might think most desirable. 



Esmarch's Bandage in Popliteal Aneurism. 

A discussion on this subject, at the Clinical So- 
ciety of London, not long since, developed seri- 
ous objections to the employment of this measure 

Mr. Herbert Page.,had tried the bandage with- 
out success in a case apparently well suited for it, 
and in the hospital at the same time a case of 
Mr. Lane's was treated in the same way with a 
like result. The plug in the distal arteries, which 
had been thought to precede clotting in the 
aneurism, was, in his opinion, a later event, and 
followed its cure. He alluded to a case of Mr. 
Pemberton's, where this method of treatment 
had been followed by gangrene. 

Mr. Bryant related a case where the bandage 
was used for one hour, under the influence of 
morphia, by which time there was much consoli- 
dation. In two or three days the aneurism grew 
worse ; but the bandage under chloroform for 
three-quarters of an hour was followed by much 
improvement. It soon relapsed, and he then tied 
the artery. Gangrene followed in a few days, 
which required amputation below the knee. In 
his opinion, the bandage was responsible for the 
gangrene ; and it constituted a serious, though 
perhaps not fatal, objection to its use. 

Dr. Mahomed considered the bandage was con- 
traindicated in cases of extensive arterial disease. 
He had found that when the bandage was placed 
on one arm the' volume of the other was much 
increased, showing that a considerably increased 
distention of the rest of the vascular system re- 
sulted. Where the cerebral arteries were dis- 
eased, this might be dangerous ; but this objec- 
tion did not apply to the ligature. 



— Smallpox has broken out quite severely in 
Dublin. For many years the United States has 
not been so free from it as this Avinter. 



146 



Reviews and Book Notices, 



[Vol. xl. 



Reviews and Book Notices. 

:notes on current medical 
literature. 

The Detroit Medical and Library Associa- 
tion commenced the publication of its Transac- 
tions, quarterly, in January. 

In a reprint from the American Journal 

of the Medical Sciences, Dr. W. W. Keen reports 
a case of cholecystotomy. It resulted fatally. 

The Annual Report of the Presbyterian 

Eye and Ear Charity Hospital, Baltimore, Md., 
records the history of the first year of that foun- 
dation. 

A case of umbilical hernia in the adult 

is described by Dr. W. W. Potter, in a reprint 
from the Buffalo Medical and Surgical Journal. 
The case is a rare one. 

The 25th Registration Report of Rhode 

Island has the usual carefully prepared statisti- 
cal tables. Under the efficient supervision of 
Dr. E. M. Snow, it is always a model of its kind. 

Dr. H. Wardner, of Cairo, 111., gives a 

summary of 163 cases of fracture of the neck of 
the femur. In regard to the modes of treatment, 
the results as given are favorable to the use of 
Hodgen's splint and Truesdale's fracture bed ; 
but the number of cases reported is not sufficient 
■to warrant a decisive opinion. Reprint from the 
Chicago Medical Journal and Examiner. 

Dr. Isaac N. Kerlin, Superintendent of 

the Pennsylvania Training School for Feeble 
Minded Children, has had printed a very useful 
pamphlet, containing information relating to the 
school, just the kind that parents and guardians 
.are constantly seeking. All who have such un- 
fortunate charges should obtain a copy. The 
.address of the school is Media, Pa. The 26th 
annual report of the institution is also published. 

A monograph by Dr. Edward Borck, of 

St. Louis, on fracture of the femur, is based on 
the author's articles on that subject which have 
appeared in the medical journals. He begins 
with a description of the method and apparatus 
which he uses, and proceeds with a review of 
various other appliances used in the same acci- 
dent. The illustrations are numerous, and the 
topic is well handled. St. Louis, George 0. 
Rumbold & Co. 

The Annual Report of the Surgeon Gen- 
eral of the Navy, for 1878, gives the usual statis- 
itics and information: — 

At the close of the year" 1876 there remained 



under treatment 332 cases; during the year 1877 
there occurred 10,457 cases of disease, injury, 
etc., making a total of 10,789 cases treated during 
the year; of which number 191 died and 10,203 
were returned to duty or discharged the service, 
leaving 395 cases under treatment at the close of 
the year 1877. 

The average strength of the Navy (officers, 
seamen, marines, engineer service, and Coast 
Survey included) for the year 1877, as near as 
can be ascertained, was 8609. The proportion 
of cases admitted to the whole number of persons 
in the service, was about 1.02, or each person 
was on the sick-list 1.02 times during the year. 
The proportion of deaths to the whole number 
of persons in the service was .02, and the pro- 
portion of deaths to the number of cases treated 
was .02. 

Of the 191 deaths during the year, 98 were 
from drowning, from the wreck of the United 
States steamer Huron, November 24. 

The total number of deaths from all causes re- 
ported to the Navy Department, from October 1, 
1877, to October 1, 1878, was 197. 



BOOK NOTICES. 

A Practical Treatise on the Diseases of the Testis, 
and of the Spermatic Cord and Scrotum. By 
T. B. Curling, f.r.s., etc. Fourth edition, re- 
vised and enlarged. Philadelphia, Lindsay k 
Blakiston; cloth, 8vo, pp. 650. Price |7. 50. 

For many j-ears the monograph of Mr. Cur- 
ling, on the testis, has been so complete and sat- 
isfactory that no other has been attempted in 
our language. The wide experience of the 
author, and his facilities in the great London 
hospitals to study an unbounded diversity of 
cases, has enabled him to give his treatise a full- 
ness which left no room for competitors. 

In the present edition he has taken advantage 
of the recent pathological researches of the Ger- 
man histologists, to review and bring up to the 
latest mark of science all that relates to the 
pathology of the testis, and has also introduced 
some new subjects, as congenital hydrocele of 
the spermatic cord, and lymph scrotum. Nu- 
merous references throughout the text indicate 
that whatever contributions have been made to 
the subject of the monograph, of recent years, 
have been carefully weighed. In fact, it is obvi- 
ous that, for some years to come, any one who 
wants to study up the diseases of the scrotum, 
and its contents, will have to turn to this as his 
best authority. 



Feb. 15, 1879.] Reviews and Book Notices. 



147 



On Loss of Weight, Blood SpittiDg, and Lung Dis- 
ease. By Horace Dobell, m.d.. Consulting 
Physician to the Royal Hospital for Diseases 
of the Chest, etc. London, 1878, pp. 274. J. 
& A. Churchill. 

At present we should be at a loss to name any 
one in Great Britain whose writings on diseases 
of the lungs and heart repay earnest study more 
richly than those of Dr. Horace Dobell. What- 
ever comes from his pen has in it that happy 
combination of j)ersonal clinical observation with 
the '' traditions of learning" which Lord Yeru- 
1am laid down as the highest quality of medical 
teaching. This is again admirably illustrated in 
the work before us. He takes up the three con- 
ditions mentioned in the title — spitting of blood, 
progressive emaciation, and pulmonary disease 
— and studies them exhaustively, with regard to 
causation, significance, and management. The 
two chapters on treatment, the one on the treat- 
ment of haemoptysis, the other on the loss of 
weight, especially as they relate to pulmonary 
consumption, are the most complete of the kind 
that we could anywhere point out. The ana- 
lytical tables of cases, the summaries of obser- 
vations and results, the tables of diet for con- 
sumptives, and the chromo-lithographic plate, we 
have space only to enumerate, though they merit 
far more than a passing notice. 

A Century of American Literatui*&. By H. A. Beers. 

Henry Holt & Co., New York. 12mo, pp.407. 

Price ^1.00. 

Mr. Beers is assistant professor of English 
literature in Yale College, and a gentleman whose 
qualifications for such a work as the present can- 
not be questioned. It consists of selections from 
some forty or fifty of the most eminent American 
authors, prefaced with biographical sketches, and 
introduced by an essay on the literature of the 
colonial period. Confining himself to authors 
no longer living, and to writers of literature 
proper, that is helles lettres, Mr. Beers, in the 
compass of a small volume, has been enabled to 
present a most interesting series of characteristic 
extracts. 

A Practical Manual of Diseases of Children, with a 
Formulary. By Edward Ellis, m.d. Third 
Edition. New York, Wm. Wood & Co. , 1879 ; 
pp. 213. 

Dr. Ellis' work first appeared ten years ago, 
since which time the author has removed from his 
London practice to the remote colony of New 
Zealand, from which distant point he edits the 



present issue of his work. Perhaps this puts him 
at a little disadvantage, in spite of the facilities of 
communication. Last year, when the English 
edition appeared, we recollect that after a careful 
perusal of it there seemed some want of famili- 
arity with various subjects in paediatrics which 
the active practitioner in a medical centre would 
have had. Apart from this, Ellis is a useful 
author "to have in the house.'' The principal 
criticism on his book is that there is too little 
of it. On many points he is unsatisfactorily 
brief. In fact, to put the wide range of diseases, 
and a formulary and dietary to boot, in a couple 
of hundred pages, and do it with reasonable com- 
pleteness, is an impossibility. He cannot average 
much beyond a page to a disease ; and that is 
obviously absurdly inadequate. Yet of its kind, 
his epitome is as good as any we know. 
A Tabular Handbook of Auscultation and Percus- 
sion, for Students and Physicians. By Herbert 
C. Clapp, A.M., M.D. With four plates. Bos- 
ton, Houghton, Osgood & Co., 1879. Cloth, 
8vo, pp. 97. Price $2.00. 
The tabular arrangement of symptoms has 
many advantages, and is deservedly popular. In 
the present work the author has arranged those 
relating to the heart and lungs, in a perspicuous 
manner, drawing his information from leading au- 
thorities. He does not. however, take advantage 
of the comparative or differential plan of stating 
symptoms ; and we notice that under pericardial 
effusion he repeats the old and inaccurate state- 
ment about the pyramidal-shaped area of dull- 
ness, and does not refer to the interesting studies 
of his fellow townsman, Dr. Rotch, on the real 
signs of this lesion. The book is handsomely 
printed and neatly bound. 

Lecture Notes on Chemical Physiology and Pathology. 
By Victor E. Vaughan, m.d., ph.d. Lecturer 
on Medical Chemistry at the University of 
Michigan. Second Edition, revised and en- 
larged. Ann Arbor Publishing Co., 1879. 
Cloth, 8vo, pp. 314. 

The preface informs us that these notes have 
been especially prepared for the use of the stu- 
dents of the author. Whether it would not be 
better to let them make their own notes is a 
question which naturally suggests itself. The 
subjects treated of are the usual ones in such 
a course — digestion, the bile, the blood, the tis- 
sues, urine, etc. No originality is claimed or 
needed in the book ; but accuracy, so far as we 
have examined it, is maintained, and this is the 
chief point. 



148 

Medical and Surgical 



Editorial. 



[Vol. xl. 



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the process. Natural selection would, however, 
be fairly satisfied by so much variation on both 
sides as should leave men susceptible of infec- 
tion, but not to a fatal degree. 

Dr. Richardson's theory, supported by strik- 
ing experiments, that the contagium is the dis- 
eased secretion of one or other of the glands of 
the human body itself, which possesses the pro- 
The terms of subscription to the serial publi- \ P^rty of altering the kindred secretion in a pre- 
viously healthy body by catalytic action, might 
at first sight appear to give little scope for the 
operation of natural selection ; but it will be ad- 
mitted, on consideration, that any matter which 
possesses the property — never mind how — of re- 
producing its like with possible variations is, ipso 
factOj subject to that law. If the first step be 
granted, that a morbid secretion can in any degree 
induce a similar morbid action in another body, 
there is no reason for denying that the process 
might in time attain the most virulent infectious- 
ness. Spontaneous origination of infectious dis- 
ease on the glandular hypothesis can hardly be 
understood unless we suppose that for each gland 
there is a certain specific disorder of function 
into which it is liable to fall, either under intrinsic 
nervous disturbance or under the contact influ- 
ence of foreign morbid secretion. 

These interesting studies will bear a much 
greater extension than has been given them by 
Dr. Airy. We have yet to see the application 
in full detail of the doctrines of natural selection, 
increase, diminution and survival, according to 
evolutional laws, applied to pathology and dis- 
ease. Some years ago we gave a brief abstract 
of the very admirable essay on the Darwinian 
theory applied to epidemics and contagious dis- 
eases, by DeCandolle, of Geneva, which still 
remains the best of its kind. 

The effort which has lately been made in Ger- 
many, to study diseases, not according to general 
similarities, as has hitherto been done, but in their 
local and temporal aspects, will furnish valuable 
material when such a mode becomes widely 
adopted. That is, the effort should not be, in 
describing a local outbreak of scarlet fever, for 
example, to yest content with its ideatificatioQ 



THE DARWINIAN DOCTRINES AS APPLIED TO 
THE STUDY OF DISEASE. 

A thoughtful paper was read, not long since, 
before the Epidemiological Society of London, 
by Dr. Hubert Airy. His subject was " Infec- 
tion, regarded from a Darwinian Point of View." 
He discussed the two theories of infection ; (1) 
the germ theory, or theory of contagium vivum, 
of which, perhaps, Dr. William Roberts is the 
foremost advocate in the British medical world ; 
and (2) the glandular secretion theory of Dr. 
Benjamin Richardson. 

On the former hypothesis it is plain that we are 
dealing with a case of parasitic adaptation. If the 
contagium is a living organism, depending for 
its support upon human susceptibility, it must 
itself be capable of variation to match the vari- 
ability of its human home and food. As the 
human syncrasy varies in the direction of insus- 
ceptibility, so the parasitic microzyme will, step 
for step, attain new virulence ; and as long as 
man and microzyme are allowed to meet, there 
would seem to be no possibility of a cessation of 



Feb. 15, 1879.] 



Editorial. 



149 



with that disease, but to discover, arrange, clas- 
sify and analyze the slight local and ephemeral 
peculiarities of the epidemic. These traits are to 
disease what the individual and accidental varia- 
tions are to the study of the origin of species in 
natural history. 

Again, the variations of pathological products 
form a field as yet quite unexplored. Virchow, 
indeed, has categorically denied that the Dar- 
winian law has any application in pathology. 
But, pace that great master, however weighty his 
authority, it does not close discussion on the sub- 
ject, and all that he can mean is that lie has not 
observed any operation of the law. 

Finally, there is a remarkably rich field open 
in the study of disease in the lower animals. 
This was touched upon, but only so, in the paper 
of Dr. Airy. He justly observed that each dis- 
ease has a history and a pedigree which we ought 
to know if we are to obtain a full scientific insight 
into its nature and relations. This should be the 
object of a new science of comparative pathology 
parallel to that of comparative anatomy. A com- 
parative study of disease in different races of 
mankind, especially in the lowest, extending to 
the quadrumana, and thence downward through 
the whole animal kingdom, might be expected 
to throw light on many of the simple elements of 
disease, on inflammatory and degenerative 
changes, on malignant growths and functional 
aberrations. 

Every day brings more and more into relief 
the intimate relations between the diseases of do- 
mestic animals and of man. It should not be 
forgotten that from this study has been derived, 
in vaccination, our greatest victory over epidemic 
disease in man. And it were much to be wished 
that more earnest attention were given to this 
branch by medical men. 



THE ADVANCE OF THE PLAGUE. 

It is stated by the sanitary authorities at Wash- 
ington that the disease prevailing in southern 
Russia has been definitely recognized by the 
Russian health authorities as the plague. At As- 
tracan there were 195 cases, of which 143 proved 
fatal, during the first two days of January. Pre- 



cautions are being taken by most of the Euro- 
pean governments against its introduction into 
their respective countries. 

In the last week in January, a St. Petersburg 
despatch says, ''The timely and energetic meas- 
ures adopted by the Russian Government, and 
the promptitude with which the information was 
communicated to the public, are proofs that the 
time is past for bureaucratic mystery in a matter 
affecting the public health." 

Early in February the Czar approved the sum- 
mary measures resolved upon by the committee 
of Ministers for stopping the plague. All reme- 
dies proved unavailing. The local Sanitary Com- 
mission of Moscow decided upon the most strin- 
gent precautions, such as the closing of unhealthy 
basement dwellings, the erection of buildings to 
accommodate two thousand people, and of fur- 
naces for burning infected clothes, and the 
gratuitous distribution of cooked provisions. 

Russia has asked England to send medical 
men to report on the epidemic. 

At Bucharest, the Chamber of Deputies voted 
a credit of five hundred thousand francs for the 
establishment of a quarantine and a military 
cordon, to prevent the spread of the plague. 

At Vienna, on Jan. 26th, the International 
Sanitary Commission, which met there to take 
precautions against the spread of the plague, con- 
cluded its labors for the present. It decided 
that the regulations relative to arrivals from 
Russian ports can, if necessary, be applied to 
arrivals from ports on the lower Danube. Herr 
FiNKELNBURG, the German delegate to the Inter- 
national Sanitary Commission, started for Berlin 
at once. The Montags Revue says Herr Fink- 
ELNBURG declared that should the plague increase 
Germany would establish a military cordon of 
80,000 men on her frontier, and that the order 
for their mobilization was ready. 

Such precautions are not premature, as all who 
have studied the history of this terrible scourge 
will acknowledge. 

This form of the plague is the '' Black Death " 
of the fourteenth century, the blight which fell 
upon London in 1663, and destroyed nearly hal f 



I50 



Notes and Comments. 



[Vol. 



of the population of Marseilles in 1720. Since 
that dread visitation in Southern France it has 
not returned to Western Europe, save in 1816, 
when it crossed the threshold of Naples. In 
1771 Moscow was under the curse, and several 
times during the present century has the plague 
passed over the Danube to lead a dance of death 
in Southern Russia. During the terrible winter 
of 1828-29, before Diebitsch led an army of in- 
valids across the Balkan, and through sheer au- 
dacity dictated the peace of Adrianople, the 
plague swept over Roumania until 2000 villages 
were infected and 82,000 Russian soldiers were 
lost in the hospitals. From May, 1828, to Feb- 
ruary, 1829, the sick list comprised over 210,000 
names, and inasmuch as Von Moltke, the histo- 
rian of the campaign, estimates that the whole 
strength of the army could not have been over 
100,000 men, every soldier, on the average, was 
twice in the hospital. As early as May, 1829, 
the plague broke out on the right bank of the 
Danube, and before the winter set in the victori- 
ous army was almost wholly destroyed, for not 
more than 10,000 men recrossed the Pruth, and 
manv of these were recruits. 



treatment, enforced cleanliness, and strictly regu- 
lated diet and habits. It is certainly a remark- 
able fact that districts in which the lowest 
prostitutes abound, and in which every one of 
I them is known, should, when subjected to regu- 
I lar inspection, only quite exceptionally furnish 
examples of really formidable venereal disease."" 
We suppose the "unco guid"' will very much 
object to this diminution of the suffering of a 
wretched class of unfortunates. 



Notes and Comments. 

Kesults of the Contagious Diseases Aets. 

These acts, as is generally known, are directed, 
among other things, to the prevention of syphilis 
by enforcing police surveillance and medical ex- 
amination of prostitutes. In his just published 
Lecturen on Syphilis, Mr. James R. Lane, sur- 
geon to the Lock Hospital, London, says of their 
effect: "Nothing could be more striking than 
the change which was wrought in the character 
of the cases coming in from a district after it had 
been under inspection for two or three months. 
At present, if a severe case presents itself among 
this class of patients, it is almost sure to be in some 
unfortunate who has migrated from a distance 
into the inspected district, in order to secure being 
sent at once into hospital for treatment. The 
sores are now of the mildest character ; phage- 
dsena is almost unknown ; and, what is equally 
remarkable, even suppurating buboes are but 
rarely seen. The present condition of these wo- 
men is a striking illustration of the extent to 
which venereal disease may be mitigated by early 



i Poisoning by Chlorate of Potasli. 

j This drug is so freely used as a domestic reme- 
j dy, that the following case, which occurred in 
the family of Dr. Kauffmann, of Berlin, will be 
read with interest. It is given in the Med. Cen- 
tral Zeitung : He used to keep a certain quan- 
tity of this salt in a tin box, and give some of it 
daily to his children, as prophylactic treatment 
against diphtheria, which happened to be epi- 
demic at that time in the neighborhood. One 
day, the children, while playing, possessed them- 
selves of the box, and took each about half an 
ounce of the chlorate of potass. The youngest 
child, a girl two years and a half old, had severe 
vomiting, which lasted for seven hours, when 
she died of gastritis, in spite of all help. Another 
remarkable symptom of the poisoning was the 
profound lethargy of the child, which probably 
prevented its showing symptoms of pain. An- 
other similar case is mentioned, of a young man 
who had taken small doses of chlorate of potass, 
to cure himself of hoarseness. From the time of 
taking the first dose to the moment when he left 
off, the patient suffered from gastritis, and 
vomited every time he took the drug. These 
symptoms ceased as soon as the medicine was 
discontinued, which clearly shows it to have 
been the primary cause of the inflammation. 



Eolation of Diphtheria to Potato Blight. 

The eminent physiologist. Dr. Alfred Carpen- 
ter, says, in a recent paper : The close analogy 
which exists between diphtheria and potato blight 
leads me to conclude that the conditions which 
promote the one have also an influence upon the 
other, which requires wide- spread observation 
for its determination. There is a close analogy 
between dry rot and potato disease, which con- 
nects the three classes of disease into one genus. 
Circumstances which are common to one may be 
common to another, and those things which in- 
crease the productive power of the one have a 
similar effect upon the other, and vice versa. 
Thus, a germ of the fungus called merulius lac- 



Feb. 15, 1879.] 



Correspondence, 



15 



rymans^ in contact with immature wood, in a 
position in which there is a want of ventilation 
and where some moisture is present, very soon 
produces its effect and sets up dry rot in the lig- 
neous tissues. But an excess of carbonic diox- 
ide is required to promote the change in the al- 
buminous matter of the wood ; this excess is 
provided by ordinary oxidizing processes in a 
badly ventilated structure. The fungus then de- 
composes the wood into carbonic dioxide and 
water. Thus are produced the two elements 
which are required to continue the mischief, and 
there is a rapid destruction of the building. 



Suggestion for Sleeplessness. 

Many persons troubled with insomnia also 
suffer from cold feet. An English writer sug- 
gests that the feet be dipped in cold water for a 
brief period ; often just to immerse them, and no 
more, is sufficient 5 and then they should be 
rubbed with a pair of hair flesh-gloves, or a 
rough Turkish towel, till they glow, immediately 
before getting into bed. After this, a hot-water 
bottle will be successful enough in maintaining 
the temperature of the feet, though without this 
preliminary it is impotent to do so. Disagree- 
able as the plan at first sight may appear, it is 
efficient ; and those who have once fairly tried 
it continue it, and find that they have put an 
end to their bad nights and cold feet. Pills, po- 
tions, lozenges, "night-caps," all narcotics, fail 
to enable the sufferer to woo sleep successfully ; 
get rid of the cold feet, and then sleep will come 
of itself. 



Syphilitic Milkmen. 

An English writer, Mr. George Gaskoin, has 
lately directed attention to the possible infection 
of milk through that very common form of sec- 
ondary syphilis, psoriasis palmaria, on the hands 
of the men engaged in milking. He remarks : 
" Although the subject is of an unpleasant char- 
acter, I think it would be possible to insist on a 
great circumspection in the choice of men who 
have this duty to perform. If the ' neat-handed 
Phillis ' is to be discarded, which I cannot but 
think of with regret, we ought to be very partic- 
ular in the class of men employed. Thus, for 
instance, it is obvious that discharged soldiers and 
seamen, in whom the probability is not small that 
they may have had syphilis, are not the people we 
should make choice of for milking our cows ; 
but, in short, whoever has had this complaint in 
any degree, or at any period of his existence, is 
unsuited for so delicate a duty." This warning 



is very applicable to the dairies around Philadel- 
phia and New York, where the " milk maids" 
are usually boys and men. 



Correspondence, 



Ice Treatment of Pseudo-membranous or True Croup 
in Children, and Acute Laryngitis in the Adult. 

Ed. Med. and Surg. Reporter : — 

This hitherto fearful malady, whose ravages 
have hurried so many children to an untimely 
grave, I am convinced, by the experience of the 
last five years, is as easily controlled by the use 
of proper measures vigorously and promptly em- 
ployed, as most of the other phlegmasiae. Let 
me premise a word in relation to its pathology. 
True croup is an inflammatory affection of the 
mucous membrane of the trachea, extending in 
some instances to the larynx above and to the 
bronchi below, which may be characterized by 
the epithet exudative, i. e. , accompanied with 
the exudation of a fibrinous compound upon the 
free surface of the tracheal mucous membrane, 
adhering there and accumulating as the disease 
progresses, and blocking up, as it were, the wind- 
pipe, and thus shutting off the respiration. There 
is an anatomical difficulty in getting rid of this 
product of the inflammation, even were it to be- 
come detached. This difficulty consists, in part, 
in the peculiar conformation of the glottis, and 
also in its extreme sensibility, which will not tole- 
rate without spasm the touch of anything from 
within or without, except atmospheric air. To get 
rid, therefore, of the inflammation, and thus to ob- 
viate its consequences — death by suffocation — is 
the paramount indication in its treatment. I am 
abundantly satisfied, by ample experience, that 
we are in possession of no remedy that will meet 
this indication so surely and so expeditiously as 
ice, and notwithstanding the apprehensions of 
the old women, and the condemnation of medical 
men in high standing, I would now no more 
think of treating true croup without ice, than of 
treating a severe attack of malarial fever without 
quinine. 

Let the little patient's chest be protected by 
two or three folds of flannel, and let a bladder 
partially filled with coarsely pounded ice be ap- 
plied in front of the neck, and retained there 
closely, and as soon as the ice in the bladder 
becomes melted, or nearly so, let it be immedi- 
ately replaced by another which has been pre- 
pared beforehand, thus giving no time for injuri- 
ous reaction in changing the bladders. The ice 
should be unremittingly applied, till the last 
vestige of the peculiar metallic or brassy sound 
is no more to be heard in the cough. 

The employment of ice does not preclude the 
use of other appropriate measures, as a mercu- 
rial cathartic, occasional emetics, verat. virid., 
tart, antim., etc. Spasm of the glottis being an 
extremely distressing element in most cases of 
this disease, the patient should at once be brought 
fully under the influence of belladonna (evinced 
by dilatation of the pupils and capillary conges- 
tion of the face), and so kept under its influence 
throughout the whole course of the disease. 



152 



Correspondence. 



[Vol. xl. 



When we study tlie physiological action of this 
medicine in connection with the spasmodic ele- 
ment of croup, the beneficial influence of this drug 
cannot fail to be seen and appreciated. 

Acute laryngitis is not a very frequent disease 
in this section. In a continuous practice of over 
38 years I have encountered only four well- 
marked cases. In acute laryngitis we have not 
the fibrinous deposit, as in true croup, but in its 
stead, infiltration into the abundant loose sub- 
mucous areolar tissue about the glottis, and, per 
consequence, death by apnoea. It is an admit- 
ted fact, that the treatment prescribed in stand- 
ard works for this particular form of croup, and 
for acute laryngitis, is notoriously unsatisfactory 
in its results — failure being the rule, success the 
exception. It is true I have treated but one case 
of well-marked acute laryngitis in the adult since 
adopting the ice treatment. In this instance the 
disease was ushered in with rigor, followed by 
heat of surface, pulse 135, tenderness over the 
pomuTTi adami, complete aphonia, painful deglu- 
tition, every movement of the tongue accompan- 
ied with pain. Ice in bladders was unremittingly 
applied to the front of the neck for four days and 
nights; cal., tart, antim., verat. virid., etc., were 
used ; but without the ice I would have had but 
little confidence in any treatment. Permit me to 
say that if I were restricted to the use of but one 
remedy in these two inflammations, that remedy 
would be ice, emphatically, ice. 

J. N. NORRIS, M.D. 

Birmingham, Iowa. 



Leonnrus Cardiaca in Asthma, 

Ed. Med. and Surg. Reporter: — 

I would call the attention of the profession to 
the use of this plant as a therapeutic agent of 
marked value in spasmodic asthma, and other 
diseases of kindred character, such as palpitation 
of the heart, hysteria, etc., and all of that class 
of affections usually styled nervous in popular 
parlance, and which seem to depend upon mor- 
bid excitability, or erethism of the nervous sys- 
tem. I do not claim that I am presenting a new 
remedy to the profession, only a new application 
of an old and valuable agent, which, in my opin- 
ion, has been too much overlooked and neglected. 
Its common name, motherwort, points to the 
fact that it has been long known as a remedy in 
certain diseases peculiar to females (notably, 
hysteria). I found it in popular use as a remedy 
for palpitation of the heart, and I have myself 
prescribed it with pleasing results in functional 
derangements of that organ resulting from ner- 
vous exhaustion, the debility of convalescence, 
mental over-strain, and grief, using it as a calm- 
ant to the nervous system in those cases in which 
I wished to avoid the routine practice of giving 
opiates ;_ but it is to its use in spasmodic asthma 
that I wish to call the attention of the profession 
more particularly. 

I had a case of spasmodic asthma which I had 
been treating for about twelve years, and had 
nearly exhausted my resources and my patience, 
had used nearly everything recommended in 
books and journals, including the much vaunted 
grindelia robusta, with not very encouraging re- 



sults. I was called in haste to relieve this pa- 
tient, and having prepared some of the remedy, 
I took it along with me, as I had tried nearly 
everything else I could learn of, and wished to 
give this anti-spasmodic a test. I directed a 
teaspoonful of the saturated ethereal tincture of 
the plant to be taken every twenty-five or thirty 
minutes until relieved. I had a patient very ill 
a short distance from this one, and I left to visit 
him, but returned before the third dose was 
given, and to my astonishment found my asth- 
matic patient almost completely relieved of the 
paroxysm. She thanked me, and said that she 
had never tried anything which had afforded her 
such prompt and perfect relief, and this it con- 
tinued to do so long as she took this remedy, in 
subsequent attacks. It may be proper to state 
that this patient was a woman who had passed 
the climacteric for some years, was a sensible per- 
son, not subject to hysterical attacks. I prepare 
the remedy myself, in this way : I dry the plant 
in the shade, thoroughly ; then rub the leaves in 
my hands, to break them up fine, and cut the 
stems and tops fine, and pack them in a large 
glass lamp chimney, filling the small end of the 
chimney with cotton ; cork up the small end, 
and moisten thoroughly with spirits nit. dulcis 
and water, equal parts ; let it macerate for three 
or four days, remove the cork, place a large rag 
or filtering paper over the small end, place the 
chimney in a glass fruit jar, whose mouth is 
small enough to hold the chimney by its tapering 
sides a considerable distance from the bottom of 
the jar ; then displace with pure spirits nit. dul- 
cis. The tincture which passes through should 
be passed a second, or even a third time, through 
the percolator ; the object is to secure a thorough- 
ly saturated tincture ; add one drop of oil of 
anise to each drachm. Prepared in this way, it 
is a pleasant remedy to take, and looks like a 
fluid extract. This a rude pharmacy, but rural 
doctors, like myself, will appreciate it. I have 
used the simple infusion with good effect. The 
plant is a perennial, not a native, but has been 
introduced. Darlington calls it an "unsightly 
weed ;" I do not agree with him ; to me it is a 
beautiful plant, and worthy of more extended use 
as a medicine. 
Ferrt/sville, Ind. E. T. Spottiswood, m.d. 



An Anencephalus Monster. 

Ed. Med. and Surg. Reporter : — 

January 11th, 1879, I was called to see Mrs. 
L. , who was about to give birth to her second 
child. I found the os uteri rigid, with annoy- 
ing, though not effective pain ; I gave her three 
grains of ipecac; waited near half an hour, when 
the uterus acted well. Made a second examina- 
tion ; found the os well dilated, with a peculiar 
body inside which would recede from my touch, 
so I could not determine its character. I then 
ruptured the membrane, when about one and a 
half gallons of liquor amnii passed off (the larg- 
est amount I ever met in one case). The uterus 
contracted quickly after the discharge of the fluid. 
I then found an anencephalus monstrosity, which 
was born in a few minutes. The child was plump, 
but rather small, and never respired, as the me- 



Feb. 15, 1879.] 



Correspondence. 



153 



dulla oblongata was absent. The auditory canal 
was perfect, but the pinna of the ear was unusu- 
ally small and a little deformed. There was a 
serous membrane, with a well marked cicatrix 
near its centre, that lay on the base of the cra- 
nium. I did not notice a vascular tumor, as re- 
ported at the base of the skull in the majority of 
such cases. I do not remember of ever reading 
or hearing the cause of this class of deformities ; 
but from the cicatrix and appearance of the mem- 
branes lying on the base of the skull, I concluded 
this case was caused by an ulcer destroying the 
absent part during the early period of gestation, 
and then healing, leaving only its footprint. If 
any one will furnish a better hypothesis I would 
be pleased to hear it. 

The mother was healthy, and gave no signs of 
constitutional trouble. She gave birth to a per- 
fect child about three years ago. She did not 
anticipate anything wrong in this case, and had 
no cause by which to account for the defect, as 
mothers usually have. The case is certainly a 
rare one, and one of interest to me, so I report 
it, for the benefit of others. 

H. G. Clippinger, m.d. 

Pipeston, Mich., Jan. 28th., 1879. 



Instance of False or Simulated Labor. 

Ed. Med. and Surg. Reporter : — 

Not long since, Mr. N. A. called at my ojfice, 
stating that his wife had rheumatism ; was preg- 
nant for four months. I prescribed the usual 
remedies. Did not hear anything more for 
about a week, when he again called, saying she 
was no better with the rheumatism, and that she 
was bloating all over, from head to feet, as he 
said, suffering intensely. I again prescribed, 
as I thought, to suit the case, but in a few days 
I was called in great haste to see her. Upon 
my arrival she was sitting in a large arm chair, 
having all the appearance of a woman at full 
term, with the addition of the cellular tissue 
being invaded with liquor to the fullest capacity ; 
in fact, she made a frightful appearance. I 
stated to her she must have been mistaken in 
regard to pregnancy. She said she was not. 

I proceeded to make an examination per vagi- 
nam. Was surprised to come in' contact with a 
large sac of amniotic fluid, extending down in the 
vagina, the os being greatly dilated. Just at this 
juncture the membranes ruptured, and the amount 
of liquor escaping was beyond anything I ever 
experienced in all my practice. At this time I 
was almost certain that labor was at hand, and 
told the husband that he could calculate upon 
receiving an increase in his family. The lady 
said she felt immediate diminution of all her 
suffering, and after the liquor had escaped she 
felt no more rheumatism or any inconvenience 
from the anasarca ; indeed, the anasarca gradu- 
ally subsided, so that in two or three days the 
cellular tissue was in a normal condition, and 
remained so. After the liquor had all escaped, 
I proceeded to make another examination, when, 
to my great surprise, I found the uterus was con- 
tracted to the size of a four months' pregnancy, 
and the external and internal os was coutracted 
back to a normal size. 



She continued from this time on to improve, 
and in a few days was about her work as usual, 
performing the work of a farmer's house. Now 
why was all this? and where did this liquor in 
the cellular tissue go? and was this a false mem- 
brane? I ask and write this for information. 

She went on in the even tenor of her way until 
full term, when she was delivered of a large, 
healthy child. Both mother and child did well, 
and continue so up to this time. She was the 
mother of eight children prior to this, and had 
no trouble with any of them. 

J. A. Hutchison, m.d. 

Salamonia, Ind., Jan. 30th, 1879. 



Eupture of the Eyehall. 
Ed. Med. and Surg. Reporter : — 

In May last I was called to see 0. R., a car- 
penter by trade, who, while driving a nail, had the 
misfortune to have the nail rebound and penetrate 
the eyeball. He immediately pulled the nail out 
and the aqueous humor ran out into his hand. I 
am unable to say, positively, whether the crystal- 
line lens was also lost at this time or not ; one or 
two' other physicians have seen the case since the 
recovery, and think it was. The cornea was badly 
torn, and the ball of the eye much flattened, from 
the loss of the aqueous humor. I immediately 
closed the eyelids and kept them closed for ten 
days, keeping them constantly wet with water to 
which had been added a little tr. camphor, using 
it at first cold, afterward warm, as was agreeable 
to the patient. At the end of ten days 1 opened 
the lids and found the wound in the cornea 
granulating and healing well, with the aqueous 
humor reproduced, and the eyeball of its usual 
size. The improvement continued until the 
wound had entirely healed, which now leaves a 
cicatrix about one-sixteenth of an inch long, just 
underneath the pupil ; but about one-third of the 
pupil is closed by the cicatrix. Vision sufficient 
to distinguish objects and colors, etc. , still re- 
mains. The accident resembles the operation 
for cataract, except in the instruments used. 
H. W. Hendrick, m.d. 

Hyde Parh, Vt. 



Foreign Body in the Stomach. 

Ed. Med. and Surg. Reporter: — 

The following being of unusual occurrence, 
and one more instance of foreign bodies taken 
into the stomach, please give it place in your valu- 
able paper. On November 1st, 1878, a babe of 
eight months, only child of Mrs. N., was left in 
the sitting room while the mother was attending 
to her household duties, and on her return she 
found her child nearly choked to death ; finding 
the stocking off one foot, she thought of the 
shield pin, or protection pin, and concluded he 
had swallowed it. She sent for a physician, who 
not being at home when word was left, another 
doctor was called in. On receiving the sum- 
mons, I went to the house, but made no exami- 
nation. I understood from the parents that 
castor oil had been ordered for the child to take 
at bed time. The night of November 2d the 
father wished me to see the babe, as it seemed 



154 



News and Miscellany. 



[Vol. xl. 



to be choking to death, and the physician who at- 
tended in my absence refused to go. I went to 
the house, and found the child with great apncea, 
lips purple, and every indication of dissolu- 
tion. Believing that, in case the child had swal- 
lowed the shield pin open, in its course to the 
stomach a local inflammation had set up, I 
adopted a palliative course of treatment. By 
faithful attention for several days, the child im- 
proved. I ordered him to have other food, such 
as oatmeal and mashed solid food, and trust to 
nature to accomplish the removal of the foreign 
body, notwithstanding the prognosis of other 
medical men, who claimed that no one of a 
scientific turn of mind would assert that the 
child could live more than two days with such a 
substance in the stomach. But such scientific 
sophistry did not kill the child, for just eighty- 
five days from the time of swallowing the open 
shield pin, which was one inch in length, it was 
passed, in great pain, at stool, in hardened 
faeces. J. H. Tilford, m.d. 

Windom, Minn. 



News and Miscellany. 



The New York State Medical Society 

Met at its regular Annual Session in Albany, on 
Tuesday, February 4th. The meeting was at 
tended by about one hundred and fifty delegates. 
A full report of the proceedings has been for 
warded by the representative of the Reporter, 
but owing to the crowded state of our columns 
its insertion is postponed until our next issue. 



Cremation in London. 

Professor Gorini is, it is stated, " superintend- 
ing the erection of a funeral pyre on a site be- 
longing to the Cremation Society of London. 
The pyre is on the same system which has been 
approved in numerous cremations at Milan and 
other places in Italy. ' ' The works will doubtless 
be all that could be wished by those who approve 
the system. The Sanitary Council of Munich is 
reported to have recommended cremation under 
certain circumstances: — " 1. After battle. 2. 
During certain epidemics. 3. Where the trans- 
port of bodies is difficult. 4. Where the soil is 
unsuited for inhumation. ' ' 



Items. 



— St. Petersburg possesses thirty-five public 
hospitals. Of these, eleven are devoted to women, 
including three lying-in hospitals and one oph- 
thalmic hospital ; two are skin-disease hospitals ; 
three hospitals for children; fourteen general 
hospitals ; three hospitals for the insane ; and one 
hospital devoted to men only. In addition, there 
are thirty- six private hospitals and dispensaries 
in the city. 

— That science is favorable to longevity seems 
to be attested by the mortuary record of the 
Koyal Society for last year. Of nineteen members 
who died but one was under 60 ; six were between 



60 and 70 ; eight between 70 and 80, and four 
above 80 years of age. The three foreign mem- 
bers of the society who died during the year were 
aged respectively 77, 84 and 90 years. 



R. Acidi salicylici, 

Spiritus aetheria nitrlci, 

Sodii bicarbonatis, 

Spiritus lavandulas comp., 

Aquae, 

Syrupi aurantii corticis, ad 



QUERIES AND REPLIES. 

Dr. H. E. Z., of Pa.—'' Will you please give the best 
form for administering salicylate of soda ?" 

Ans.—We extract the following formula from the 
sixth edition of Napheys' Medical Therapeutics, as one 
of the best : — 

5j 
f.Svj 

gr. Ixx 
f.5ij 
f.Sij 

f.Svj. M. 
Sig. — A teaspoonful every 3 or 4 hours. 
" In preparing this prescription, mix the acid and the 
spirits of ether in a bottle, then add the soda, and 
afterward the water, gradually, till effervescence 
ceases, and then the lavender and the syrup. This 
compound is palatable, and agrees well with the stom- 
ach." (Med. Ther., p. iZO.) 

Scalpel.—"' Can you recommend an Index Rerum for 
indexing medical matters?" 

Ans.—'No special one for this purpose is prepared. 
The plan suggested by the Eev. Dr. Todd can be ap- 
plied. We used it for some years satisfactorily. News- 
paper men now prefer the envelope or card plans. 

Dr. E. G. C, of R. I.— "Can disease be communicated 
by the lunar caustic ? For instance, suppose a chancre 
is cauterized, either a hard or soft chancre, and the 
same stick of silver used to cauterize a canker sore of 
the mouth ; will the syphilitic disease be communi- 
cated?" 

Ans.—We are inclined to answer in the negative, but 
prefer to refer the question to our readers. Have any 
of them facts of this nature to report ? 



MARRIAGES. 



Alvis— Sandersois".— At the residence of the bride, 
near Chulahomo, Marshall county. Miss,, January 
ISth, 1879, at 3 o'clock, p.m., by Kev. J. D. Cameron, of 
Holly Springs, R. H. Alvis, m.d., and Miss Dannie 
Sanderson. 

Ceamp— Keeb-er.— On Wednesday, January 29th, 
1879, at the residence of the bride's parents, by Rev. 
Francis L. Robbins, d.d., Edwin S. Cramp and Rebec- 
ca Baird, daughter of W. W. Keefer, of Philadelphia. 

Davis— Peeper.— On New Year's day, by Rev. James 
Vance, of Carlisle, Pa., Dr. J. C. Davis, of Mt. Holly, 
and Ella C. Peffer. 

Pancoast— Fernald,— In Philadelphia, on the 14th 
ult., at the residence of the bride's parents, by Friends' 
ceremony, and also by the Rev. M. Ballou, Dr. S. Pan- 
coast and Carrie A., only daughter of N. M. Fernald, 
and niece of the oflaciating clergyman. 



DEATHS. 

Barker. — At Jamaica, Long Island, on the 27th 
ult., Bessie, daughter of Charles H. Barker, m.d., 
aged 16 years. 

Dickey. — In New Orleans, La , on January 29th, 
1879, Dr. W. li. Dickey. 

Fitch. — In New York, Tuesday evening January 
28th, Samuel Sheldon Fitch, m.d., son of the late Sam- 
uel Sheldon Fitch, m.d., aged 31 years. 

Williams.— In Philadelphia, on the 15th ult., 
Agnes, wife of Dr. W. Williams, and daughter of John 
J, and Rachel S. Rowan. 



I 



2^ L 




^-<-^^/L- 




WHOLE No. 1147.] FEBRUARY 22, 1879. 



[VOL. XL, No. 8. "^ 
__\ 



E $5.00 par Yf.AR. 



ESTABLISHED 1853, BY S. W. BUTLER, M.D. 



THI E 



i 

MEDICAL AND SURGICAL 

M RlEFOIETEIEs 

f 

■P OEIG 



EDITED BY D. G. BRINTON M. D. 



OOIVTEIVTS 



157 



OEIGINAL. DEPAETMENT. 

COMMUNICATIONS. 

Myers, Wobthington.— Hereditary Descent of 
Disease— Intemperance— Intermarriage of Eela- 
tives 

Hoffman, "W. J.— The Practice of Medicine and 
Surgery by the Aboriginal Eaces of the South- 
west 

HOSPITAL REPORTS. 

Howard Hospital, Philadelphia— Clinic of Dr. 
Chas. S. Turnbull— Perforating Wounds and 
Injuries of the Membrana Tympani— Traumatic 
Perforation of the Membrana Tympani, with 
Fracture of Handle of Malleus— Foreign Body 
(Bug) Eemoved after having remained Three 
Years in the Ear 161 

MEDICA.L SOCIETIES, 

New York State Medical Society— Annual Meet- 
ing 163 

EDITOEIAL. DEPAETMENT. 

PERISCOPE. 

Poultices in Eheumatic Arthritis 165 

The Treatment of Diphtheria 165 

An Operative Measure for the Arrest of Commenc- 
ing Pyaemia 166 

The Cause of Deformity in Fracture of the Lower 

End of the Eadius 166 

The External use of Digitalis in Suppression of 

Urine 166 

The Organization of Thrombus 167 

REVIEWS AND UOOK NOTICES. 

Notes on Current Medical Literature 167 



BOOK NOTICES. . 

Transactions of the American Ophthalmological 
Sociel y 168 

The Influence of Posture on Women in Gynecic and 
Obstetric Practice (Aveling) 168 

On the Treatment of Pulmonary Consumption by 
Hygiene, Climate and Medicine (Bennett) 168 

Section Cutting (Marsh) 168 

editorial. 

Cosmetic Preparations 169 

notes and comments. 

Adulterated Chloroform 170 

Theory of Death in Septicaemia and Charbon 170 

The Soda Treatment of Burns 170 

COEEESPONDENOE. 

The Frequency of Hepatic Abscess (Coles) 171 

Puerperal Convulsions (Hamilton) 171 

The Chlorine Mixture in Scarlet Fever and Diph- 
theria (Patterson) 172 

Verminal Leucorrhoea of Infants (Bennett) 172 

NEWS AND MISCELLANY. 

The Kansas Medical Act 172 

Diploma Selling 175 

Cascara Sagrado, etc., Atcain 175 

Yellow Jack Still Alive 175 

G-erman Eye and Ear Infirmary 175 

Obituary Notices— Taylor 7ance Thompson, m.d.. . 176 

Items 176 

Notice to Subscribers 176 

Personal 176 

Queries and Eeplies 176 

Marriages and Dsaths 176 



INDEX TO ADVERTISEMENTS OF HAI.F A COEUMN OR MORE. 



Billings, Clapp & Co p 4, cover. 

Burn-Brae, Private Hospital 145 

Caswell, Hazard &, Co., Solution Ferrous Chloride. 131 

Cincinnati Lancet and Clinic 138 

Codman &; Shurtletf, Vaccine Virus 133 

Conspectus of Organic Materia Medica, Brinton.. 136 

De Bary & Co., Apollinaris Mineral Water 131 

Ditterential Diagnosis, Brinton 142 

E. F. Houghton & Co., Cosmoline 138 

E. Fougera &. Co., Cod-liver Oil, etc. 132, 135, p. 3, cover. 

H. Planten & Son, Capsules 143 

Josiah Fleming, Bethesda Water 137 

Keasbey & Mattison, Dextro-Quinine 146 



London Mfg. Co. , Essences of Meats 139 

Long Island College Hospital 143 

McKesson & Bobbins, Gelatine-coated Pills and 

Globules 129 

McKelway, Syrup-Glycerole Fer. Chloride. p. 2, cover. 

New Books, jJrinton 144 

Physician's Pocket Kecord, Brinton 137 

Eeed & Carnrick, Maitine 140 

Trommer Extract of Malt Co. .. .... 134 

University of Michigan >«'*'^'^77k"*««c: ^^ 

Wyeth & Bro., Dialysed ly6n...y.i.Qtfyf>*^. p. 2, cover. 
Wm. E. Warner & Co. ' ' ' 



>e®=- When you write to one of these Advertisers, please always state that you saw 
THE MEDICAL AND SUEGICAL EEPOETEE. 



^ 



PHILADELP HIA: 
Published at No. 115 South Seventh Street. 



Press of Wm. F. Fell & Co., 733 SansomSt., Philadelphia. 




REiVIITTANCES RECEIVED. 

Week Ending February 15, 1879. 

N. B.—All Chtcks and P. 0. Orders must be drawn 
payable to the order of D. G. Brinton, m.d. 

4®" Subscribers are requested to inform us immedi- 
ately if their remittances are not acknowledged in this 
column. 

Alabama.— Bts. C. H. Franklin, O. C. Sherar^. Ar- 
kansas.— Brs. F. E. Morgan, C. D. Milner, A. J. 
Harris. California.— Dr. H. J. Crumpton. Con- 
necticut.— Vrs. A. Field, D. C. Leavenworth, S. L. 
Chase. Delaware.— Brs. Y. S. Dunlap, J. N. Johns. 
District of Columbia.— Dr. H. C. Yarrow Murphy. 
Florida.— Dt8. J. C. Whittlng, S. A. Wauchope, Gr. 
K. Cook. Georgia.— Brs. E. L. Oonally, R. Hazle- 
hurst, H. Perdue, G. F. Smith. Illinois.— Br?. R, G. 
Allen, H. W. Milligan, S. C. Wernham, J. Robbins, 
N. S. Freeman, W. D. Crawford, P. Young, B. F. 
Landis, M. Cunningham, J. Baker, "W. Dougall, J. 
Tenbrook. Indiana.— Brs. A. Leslie, A. H. Stout, 
W. P. Bailey, G. W. Robbins. Indian Territory.— 
Dr. G-. W. Morrison, Iowa.— Brs. W. W, Hale, E. 
J. Chapman, W, A. Todd, R. Stephenson, Jr., H. H. 
Maynard, D. H. Henry, N. Udell, G. W. Carter, 
B. M'Caughan. Kansas— Brs. A. C. V, McNeal, R. 
H. Vorhes. Kentucky.— Brs. J. E. Pendleton, R. D. 
Porter, J. Thurston. Maine. — Dr. C. Fuller. Mary- 
land.— Brs. J. T. Parker, W. J. Hopper, A. K. Mc- 
Snyder, J. E. Herbst. Massachusetts.— Br. C. L. 
French. Michigan.— Br. B. L, Howes, Detroit 
Medical College. Minnesota. — Dr. W. W. Mayo. 
Mississippi.— Brs. Wirt Johnson, R. L. Dunn, W. N. 
Ames. Missouri.^Brs. B. Kuhn, M. Haeler, F. W. 
Wesseler. Nebraska.— Br. Tt. S.IjB,ne. New Jersey. — 
Drs. J. F. Grandin, R. H. Lerch, E. D. Knight, M. 
F. DeHart. New York.— Brs. M. H. Hatch, L G. 
Filkins, H. G. Du:Bois, J.H. Allen, E. B. Phelps, ¥. 
E. Clark, G. A. Thayer, J. S. McNaught,P. R. Fur- 
beck, A. B. Harvey, A. S. Zabriskie. North Caro- 
lina.— Br. W. Gleitsman. Ohio. — Drs. A. L. Rizer, 
T. J. Reed, G. F. Illig. Pennsylvania.— Brs. F. 
Wagner, J. A. Houts, U. G. Mease, S. R. Rutledge, 
R. R. Bunting, W. J. Wentz, C. B. Eager, J. H Lesh, 
H. H. Riegel, A. M. Miller, J. A. Brobst, S. G. Mil- 
ler, R. McChesney, G. W. Dille, A. Easton, J. M. 
Fitzgerald. Tennessee. — Dr. J. B. Murfee. Texas. 
— Drs. Boggs & Mayes, W. Haynie, S. E. Carrington, 
W. H. Carlisle, R. F. Cook. Vermont.— Br. H. W. 
Hendrick. OFFICE PAYMENTS.— Drs. F. F. Cas- 
seday, J. H. Wehner, J. G. Young, Geo. S, McKel- 
way, S. S. White, W. R. Warner & Co., N. W. Ayer 
& Son, J. B. Lippincott & Co., E. F. Houghton & Co., 
J. Wyeth & Bro., Lindsay & BlaKiston, Central 
News Company. 

SYRUP-GLYCEROLE 




The Combination which all Forms of Iron 
must assume before Assimilation. 



Superior to all other Iron Salts in thatj while 
it is readily taken into the circulation^ and 
does referruginate the blood, it does not 
ordinarily cause constipation nor headache. 
It is very pleasant to the taste, and is un- 
alterable. 

Ferrous Chloride is a neutral salt, consequently it 
has no action upon the teeth, and may be admin- 
istered fearlessly. This fact and the delightful taste 
of my preparation render it an advantageous form 
for administration to children. Each fluid drachm 
contains one grain of Ferrous Chloride, which, 
owing to the certainty of its assimilation, is a full, 
active, adult dose. 

McKELWAY, Apothecary, 

Successor to O. S. HUB BELL. 

1410 CHESTNUT ST., PHILADELPHIA. 



WTETES 



DIALTSED IRON. 



(lEEEUM DIALYSATUM.) 



A Pure Neutral Solution of Peroxide of Iron in the 

Colloid Form. The Result of Endosmosis 

and Diffusion with Distilled Water. 

PREPARED SOLELY BY 

JOHN WYETH & BRO., 

PHILADELPHIA. 



This article possesses great advantages over every 
other ferruslnous preparation heretofore Intro- 
duced, as it is a solution of iron in as nearly as pos- 
sible the form in which it exists in the blood. It is 
a preparation of invariable strength and purity, 
obtained by a process of dialysation, the Iron being 
separated from its combinations by endosmosis, 
according to the law of diffusion of liquids. It has 
no styptic taste, does not blacken the teeth, disturb 
the stomach, or constipate tlie bowels. 

It affords, therefore, the verp best mode of admiU' 
Isterlng 



XTION 



in cases where the use of this remedy Is indicated. 

The advantages claimed for this form of Iron are 
due to ttie absence of free acid, which is dependent 
upon the perfect dialysation of the solution. The 
samples of German, French and American Liquor 
Ferri Oxidi Dialys. which we have examined give 
acid reaction to test paper. If the dialysation is 
continued sufficiently long, it should be tasteless 
and neutral. 

Our dialysed Iron is not a saline compound, and 
is easily distinguished from Salts of Iron, by not 
giving rise to a blood-red color on the addition of 
an Alkaline Sulpho-Cyanide, or a blue precipitate 
with Ferro-Cyanide of Potassium. It does not be- 
come cloudy when boiled. When agitated with 
one part of Alcohol and two parts of Ether (fortior), 
the Ether layer is not made yellow. 

Physicians and Apothecaries will appreciate how 
important is the fact that, as an antidote for Poison - 
ng by Arsenic, Dialysed Iron is quite as efficient 
^s the Hydrated Sesquioxide (hitherto the best 
remedy known In such cases), and has the great 
advantage of being always ready lor immediate use. 
It will now doubtless be found in every drug store, 
to supply such an emergency. 

Full directions accompany each bottle. 

Physicians will find our DIALYSED IRON in all 
the leading drug stores in the United States and 
Canada. 

It is put up in bottles retailing for ONE DOLiIjAR* 
containing sufficient for four months' treatment 
Large size is intended for hospitals and dispensing. 
Retail at $1.50. Price Lists, etc., sen ton application 

JOHI WYETH k m. 



THE 



MEDICAL AND SURGICAL REPORTER. 



No. 1147.] 



PHILADELPHIA, FEB. 22, 1879. 



[Vol. XL.— No. 



Original Department, 



Communications. 



HEREDITARY DESCENT OF DISEASE. 

BY WORTHINGTOIS^ MYERS, A.M., M.D., 

Of New York. 
"Visiting the iniquity of the fathers upon the children, 
unto the third and fourth generation." 

Never was there a more solemn sentence pro- 
nounced than this ; whether viewed as a direct 
communication from the Almighty, or the enun- 
ciation of a fact derived by observation from 
the page of nature, its truthfulness is equally 
indisputable. The Christian and the skeptic, the 
philosopher and the savage, must alike receive it 
as the inexorable law of their existence. 

Awful and impressive as it is, the warning is 
not apparent to all ; the overwhelming influence 
of self-love is so powerful in blinding the judg- 
ment and perceptive faculties, that even while in 
possession of abundant facts to guide them to the 
truth, thousands still resist the conviction, and 
often deride the assurance when presented to 
them by the physiologist ; nay, we have seen them 
repel it when forced upon their notice in the shape 
of some bodily deformity, mental obliquity, or 
even loathsome disease, too evidently derived 
from themselves. And here opens a wide field for 
the Christian jurist and philanthropist, one which 
the present century will undoubtedly settle, despite 
the croakings of an antiquated superstition ; a ques- 
tion as broad as the responsibility of society for 
crimes committed by individuals of feeble intel- 
lect, from propensities derived from their pro- 
genitors, and impulses fostered by the genial 
influence of the institutions of that very society 
designed to prevent them ; witness the total ab- 

155 



sence of classification in our poorhouses, prisons, 
and school houses, often under the supervision of 
individuals whose very personal appearance too 
surely convinces the beholder that they acknowl- 
edge subjection to the impulses of their animal 
existence alone. 

The study of mental diseases is rapidly grow- 
ing in interest and- importance to the profession 
at large. The question of the proper care and 
treatment of the insane engages the attention, 
not only of medical men, but of our legislators, 
boards of charities, philanthropists, and all who 
are accustomed to think upon the great matters 
which aff"ect the welfare of mankind. 

During the past hundred years marvelous 
changes have taken place in the opinions of phy- 
sicians regarding, and the conduct of the public 
toward, this most unfortunate class ; and even 
more marked is the contrast, in these respects,, 
between the present and the middle or remote 
ages. 

We know that disease is transmitted heredi- 
tarily, first, by the low condition of the physical 
organization of one or both parents; induced 
often by intemperance ; second, the intermar- 
riage of relatives. 

Among certain classes of miserably paid and 
poorly fed workmen the physical system degene- 
rates so rapidly that the children are feeble and 
puny, and but few live to maturity; and the 
grandchildren are still more puny, until, in the 
third or fourth generation, the individuals are 
no longer able to perpetuate their species, and 
the ranks must be filled up by fresh subjects from 
other walks of life, to run, pe#haps, the same 
round of deterioration. It would seem that 
startled nature^ having given warning, by the de- 



156 



Communications . 



[Vol. xl. 



generated condition of three or four generations, 
at last refuses to continue a race so monstrous 
upon the earth. We see here another of those 
checks and balances which the exhaustless wisdom 
of God preestablished in the very nature of man, 
to prevent his utter degeneration. As the comet 
rushing headlong toward the sun is, by the very 
velocity which it gains, and which seems hurling 
it into the burning mass, carried safely beyond, 
so a race of men abusing the power of pro- 
creation may rush on to the path of deterioration, 
until, arrived at a certain point, a new principle 
develops itself, the procreating power is ex- 
hausted, and that part of the human family must 
perish, or regain its power by admixture with a 
less degenerated race. 

We will take idiocy, for example, and it will be 
seen by the tables that by far the greater part of 
idiots are children of parents one or both of 
whom were of scrofulous temperament, and poor, 
flabby organization. Out of 420 cases of con- 
genital idiocy which were examined, some infor- 
mation was obtained respecting the condition of 
the progenitors of 359. Now, in all these 359 
cases, save only four, it is found that one or the 
■other or both of the immediate progenitors of 
the unfortunate sufferer had, in some way, widely 
•departed from the normal condition of health, 
and violated the natural laws. That is to say, 
•one or the other or both of them had been -vevj 
unhealthy or scrofulous ; or hereditarily predis- 
posed to affections of the brain, causing occa- 
.sional insanity; or had intermarried with blood 
relations ; or had been intemperate ; or had been 
.guilty of sensual excesses which impair the con- 
.stitution. 

This subject of the hereditary transmission of 
'diseased tendency is of vast importance, but it is 
A difficult one to treat, because a certain delicacy 
makes people avoid it ; but if ever the race is to 
be relieved of a tithe of the bodily ills which 
flesh is now heir to, it must be by a clear under- 
standing of and a willing obedience to the law 
which makes the parents the blessing or the curse 
of the children, the givers of strength and vigor, 
and beauty, or the dispensers of debility, disease, 
and infirmity. 

We know that specific disease is transmitted to 
the infant within the womb, and that the physical 
and mental characteristics of parents are thus 
entailed on posterity ; how rational is it, then, to 
suppose that the actual condition of the parent 
at the time of its procreation and gestation should 
also leave its impress on the vegetative exist- 
ence of the infant. The constant exhaustion of 
nervous energy by the unlimited exercise of the 



sexual passions of the parents will most assuredly 
seriously affect its development and leave its re- 
sults visible at a remote period of its existence. 
Seeking for the cause of the low condition of 
the bodily organization, a fertile one maybe found 
in 

Intemperance. 

Probably the habitual use of alcoholic drinks 
does a great deal to bring families into that low 
and feeble condition of body which is a prolific 
cause of idiocy. By inspection of the tables it 
will be seen that out of three hundred and fifty-nine 
idiots the condition of whose progenitors has 
been ascertained, ninety-nine were the children 
of drunkards. But this does not tell the whole 
story. By drunkard is meant a person who is a 
notorious and habitual sot. Many persons who 
are habitually intemperate do not get this name, 
even now. By careful inquiry, with an especial 
view of ascertaining the number of idiots of the 
lowest class whose parents were known to be 
temperate persons^ we found that not one quarter 
could be so considered. 

The effect of habitual use of alcohol, even in 
moderate quantities, seems to be to lymphatize 
the whole bodily organizatioir ; that is, to dimin- 
ish the proportion of the fibrous part of the body, 
that which gives enduring strength, and to make 
the lymphatic, or the watery particles, to abound 
in all the tissues. The children of persons 
so lymphatized are apt to be of a scrofulous 
character, and their children, again, are apt to 
be feeble in body and weak in mind. Thus, di- 
rectly and indirectly, alcohol is productive of a 
great proportion of the idiocy which now bur- 
dens the commonwealth. If, moreover, we con- 
sider how many children of intemperate parents 
there are who, without being idiots, are deficient 
in bodily and mental energy, and predisposed, 
by their very organization, to have cravings for 
alcoholic stimulants, it will be seen what an im- 
mense burden the drinkers of one generation 
throw upon the succeeding one. Many a parent, 
by habitual stimulus applied to his own nervous 
system, renders his child infinitely more liable to 
be made a drunkard by the ordinary temptations 
of life, than the child of a temperate man would 
be, even if living from his youth upward within 
the extraordinary temptations of a bar room. 

Another curse as fertile in the production of 
hereditary disease, or of a tendency to"vfard it, is 
Intermarriage of Belatives. 

The cases are very numerous where nothing 
extraordinary is observable in the immediate 
offspring of such unions. On the other hand^ 
there are so many cases where blindness, deaf- 



Feb. 



22, 



1879.] 



Communications. 



^57 



\ 



ness, insanity, idiocy, or some peculiar bodily or 
mental deficiency, or a manifest tendency and 
liability to them, is seen in such offspring, that 
we are forced to believe they cannot be fortui- 
tous. Indeed, the inference seems to be inevit- 
able, that such intermarriages are violations of 
the natural law, though not such flagrant ones as 
always to be followed by obvious and severe pun- 
ishment. 

If two full cousins, who are both in good 
health, and free from any predisposition or ten- 
dency to any particular disease or infirmity, 
should marry, the probability is that their imme- 
diate offspring will have tolerably good consti- 
tutions, though no one can say how much less 
vigorous in body and mind they will be than 
offspring born to either parent from some one of 
a healthy family not related by blood. 

But on the other hand, if a man in whose con- 
stitution there lurks a predisposition to any par- 
ticular disease of mind or body, inherited from 
his father's family, should marry a daughter of 
his father's brother or sister, there would be a 
strong probability that the disease or infirmity 
would appear in the offspring, while the proba- 
bility of such reappearance would be less if he 
married a healthy cousin by his mother's side, 
and still less if he married a person free from all 
unhealthy predispositions, who M^as not related 
to him at all. 

Now, as marriages between near relations are 
by no means in the ratio of one to twenty, nor 
are even, perhaps, as one to a thousand to the 
marriages between persons not related, it follows 
that the proportion of idiotic progeny is vastly 
greater in the former than in the latter case. 
Then it should be considered that idiocy is only 
one form in which nature manifests that she has 
been offended by such intermarriages. Blind- 
ness, deafness, imbecility, and other infirmities, 
we know, are more frequently the lot of the chil- 
dren of parents related by blood than of others. 

Thus we have endeavored to prove that when 
we look at humanity by the light of physiologi- 
cal science, we cannot shut our eyes to the 
conviction that the known laws of our physical 
and moral being would, if properly understood 
and obeyed, elevate our spiritual nature far 
beyond the conception of the visionary en- 
thusiasts who are so constantly deprecating our 
lost and fallen condition. All society proves the 
truth of our assertion ; wherever the genial emo- 
tions of the soul are shut out by the severer regu- 
lations of asceticism, there will ever and anon 
appear some flagrant instance of vice, the result 
of smothered passion. 



We need not j)oint to the long catalogue of 
crime, nor to the shameless conduct of the false 
moralists of the present day, who would pretend 
to have us believe that the most innocent amuse- 
ments of youth are a certain preparation for fu- 
ture crime. To the physiologist, who can only 
see the intent of nature through the written page 
of her living organism, they are equally available 
as a means of elevating the character and im- 
proving the mind of our species. He feels and 
knows, by virtue of that sublime and lofty science 
which has led him humbly and reverently to the 
footstool of his great Teacher, that her laws are 
written indelibly upon every living blade of 
grass, every insect and animal ever molded by 
her plastic hand, and are not to be disobeyed 
but with the certain result of impairing her 
handiwork and impeding her progress to the 
gr